膀胱疼痛综合征相关症状的鉴别诊断及临床意义

目的探讨鉴别诊断在女性膀胱疼痛综合征／间质性膀胱炎诊断中的重要意义。方法回顾2005年至2011年间42例转诊到广州医科大学附属广州市第一人民医院的膀胱疼痛综合征／间质性膀胱炎（IC）女性患者的临床资料。患者平均年龄49（26～69）岁，IC病程14（6～24）个月。通过详细分析病史及辅助检查（如尿动力学检查、尿道膀胱镜检、排尿期膀胱尿道造影、尿流率、剩余尿量测定、磁共振等）来探讨这些Ic病例是否存在其他泌尿系疾病，以及这些新发现的其他疾病经治疗后IC症状的改善情况。站栗尿动力学检查发现10例（24％）存在膀胱出口梗阻；排尿期膀胱尿道造影联合尿流率和剩余尿量发现16例（38％）存在远端尿道狭窄；核磁共振发现5例（12％）存在尿道憩室；尿道膀胱镜检发现21例（50％）膀胱三角区严重黏膜充血、滤泡增生明显，部分黏膜下可见弥漫脓包形成，5例（12％）存在尿道外口狭窄。42例患者根据新发现的病变进行相应的治疗，如膀胱出口梗阻或尿道外口狭窄接受尿道扩张、尿道松解术或者尿道外口成形术；膀胱炎接受经尿道膀胱黏膜电灼术；尿道憩室接受尿道憩室切除术等。42个患者中，26例（62％）的症状明显改善或完全消失，16例（38％）症状元改善。平均随访时间18（6～36）个月。结论膀胱疼痛综合征／间质性膀胱炎因与泌尿系统其他疾病的症状相似而容易被混淆。只有做好缜密的鉴别诊断才能避免误诊。

Differential Diagnosis plays a significant role in the diagnosis of bladder painful syndrome

Objective To explore the significance of detailed differential diagnosis in the diagnosis of bladder painful syn- drome/interstitial cystitis （PBS/IC）. Methods Data of 42 female patients with PBS/IC transferred to our hospital during 2005 and 2011 were retrospectively analyzed. The mean age of these patients was 49 （26～69） years, with 14 （6～24） months IC course. Detailed history was analyzed, and auxiliary examinations, such as urodynamic study, cystoscopy, voidng cystoure- thrography （VCUG）, maximal urine flow rate （Qmax）, post-void urine residue （PVR）, and MRI, were used to identify com- plicated urologic conditions. Results Urodynamic study indicated bladder outlet obstruction in 10 patients （24%） ; VCUG in combination with Qmax and PVR showed distal urethral stricture in 16 cases （38%） ; MRI documented urethral diverticula in 5 cases （12 %）; cystoscopy demonstrated trigonal severe infections with mucosal congestion and pus pocket formation in 21 pa- tients （50 %）, and meatal stenosis in 5 patients （12%）. All 42 patients with an established IC diagnosis were found to have oth- er urologic conditions and were treated accordingly with urethral dilation, urethrolysis, urethral meatoplasty, transurethral ful- guration of the bladder mucosa, urethral diverticulectomy, and so on. During the follow-up of 18 （6～36） months, 26 patients （62 %） had symptoms greatly improved or relieved after the identifiable disorders were corrected. The other 16 patients （38 %） did not respond to treatment. Conclusions Other urologic conditionsmay be ignored as they have similar symptoms as PBS/ IC, which shows that detailed differential diagnosis is important in the diagnosis of IC.