应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景尿失禁包括压力性、急迫性以及二者混合型,临床上凭经验很难准确判断其类型和程度,常发生误诊误治.目的为探讨尿动力学检查,尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值.设计回顾性平行对照观察.单位解放军第三军医大学西南医院全军泌尿专科中心.对象选择1996-01/2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例.方法①膀胱尿道造影测定患者膀胱尿道后角＜100°判定为正常,＞100°判定为异常.尿道倾斜角＜45°判定为正常,＞45°判定为异常.膀胱尿道连接部(静态时)无下降判定为正常,下降0.5 cm判定为异常.②尿动力学检查检查项目依次为充盈性膀胱测压,静态尿道压力图测定、漏尿点压测定.③分型标准膀胱尿道造影分型标准Ⅰ型膀胱尿道后角消失,尿道倾斜角＜45°,最大尿道关闭压＞20 cmH2O;Ⅱ型膀胱尿道后角消失,尿道倾斜角＞45°,最大尿道关闭压＞20 cmH2O;Ⅲ型膀胱尿道后角正常,尿道倾斜角＜45°,最大尿道关闭压＜20 cmH2O.应力性漏尿点压分型标准Ⅰ型应力性漏尿点压＞120 cmH2O;Ⅱ型应力性漏尿点压90～120 cmH2O;Ⅲ型应力性漏尿点压＜60 cmH2O;Ⅱ/Ⅲ型应力性漏尿点压60～90 cmH2O.主要观察指标①尿失禁患者尿动力学检查结果.②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较.结果120例患者均进入结果分析.①尿动力学检查结果经检查确诊为真性压力性尿失禁患者56例,症状性压力性尿失禁患者64例,其中不稳定膀胱28例,低顺应性膀胱36例.②应力性漏尿点压分型与膀胱尿道造影分型结果比较56例真性压力性尿失禁患者中Ⅰ型20例;Ⅱ型16例;Ⅱ/Ⅲ型10例;Ⅲ型10例.两种分型在Ⅰ和Ⅲ型上吻合率达到100%,Ⅱ和Ⅱ/Ⅲ型的吻合率分别达到94.1%和90.1%,无显著差异(P＞0.05)结论应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型,并对其治疗有着重要的指导作用.

Determination of stress leak point pressure in the diagnosis of female genuine stress urinary incontinence

BACKGROUND: Urinary incontinence can be divided into stress, urgent and mixed types, they can not be easily distinguished only basing on clinical experience, which often result in misdiagnose or improper treatment OBJECTIVE: To discuss the value of urodynamical inspection, especially stress leak point pressure (SLPP) determination in the diagnose of female stress urinary incontinence.DESIGN: Retrospective paralleled comparison observation.SETTING: Center of General Urology Department, Southern Hospital,Third Military Medical University of Chinese PLA PARTICIPANTS: Totally 120 female patients who received medical treatment in the uropoiesis surgical department of the Southwest hospital due to urinary incontinence between January 1996 and May 2002 were enrolled in this experiment.gle was determined and considered as normal if it was ＜100° and abnormal if ＞ 100°. Urethral tilt angle is judged as normal if ＜ 45° and abnormal if ＞45°; Urethrovesical junction (when static state) was judged as normal if not tion: including fulling urinary bladder pressure measurement, static urethral Cystourethrography classification standard: type Ⅰ refers to posterior urethrovesical angle vanished with urethral tilt angle＜45° and the biggest urethra closure pressure＞20 cmH2O; type Ⅱ: refers to posterior urethrovesical angle vanished with urethral tilt angle＞45° and the biggest urethra closure pressure＜20 cmH2O; type Ⅲ refers to normal posterior urethrovesical angle with urethral tilt angle＜45° and the biggest urethra closure pressure ＞20 cmH2O. SLPP classification standard: typeⅠ: SLPP ＞120 cmH2O; type Ⅱ: SLPP of 90- 120 cmH2O; type Ⅲ: SLPP ＜ 60 cmH2O;type Ⅱ/Ⅲ: SLPP of 60 - 90 cmH2O.compared with that of cystourethrographic classification.RESETS: Totally120 patients all remained in the final result analysis.stress urinary incontinence, 64 cases as symptomatic stress urinary incontinence including 28 cases of unstable bladder and 36 cases of low compliclassification: of the 56 genuine stress urinary incontinence, 20 cases were diagnosed as type Ⅰ; 16 cases as type Ⅱ and 10 cases as type Ⅱ/Ⅲ; 10cases as type Ⅲ. Two classification was proved of 100% consistency in type Ⅰ and Ⅲ, and 94.1% and 90.1% in type Ⅱ and type Ⅱ/Ⅲ respectively, difference was not remarkable (P＞0.05).CONCLUSION: SLPP determination can be used to make accurate classification of female genuine stress urinary incontinence, possessing important instructive significance for the treatment.