动态尿动力学与常规尿动力学检查评估女性压力性尿失禁的对比研究

Comparison of ambulatory and conventional urodynamics in females with stress urinary incontinence

目的比较常规尿动力学（CUD）和动态尿动力学检查（AUM）对女性压力性尿失禁（SUI）患者膀胱尿道功能异常检出率及尿动力学参数，探讨AUM在评估女性SUI中的应用价值。方法随机选取门诊女性SUI患者30例。年龄32～63岁，平均（49．4±9．4）岁。病程1～9年，平均（4．7±2．8）年。行尿失禁问卷表简表（ICI-Q—SF）问卷调查，根据ICI-Q—SF评分将患者分为轻、中、重3组，其中轻度尿失禁9例、中度15例、重度6例。行CUD检查和3个周期的AUM检查，分别记录并进行比较。结果30例患者AUM的SUI和逼尿肌过度活动（DO）检出率分别为90％和37％，明显高于CUD的70％和10％（P〈0．05）。对ICI．Q—SF评分为中、重度尿失禁且AUM与CUD同时检出SUI（伴或不伴急迫性尿失禁）的21例患者尿动力学参数进行比较发现，AUM组患者的腹压漏尿点压（ALPP）和排尿量显著低于CUD组（P〈0．05），逼尿肌压力显著高于CUD组（P〈0．05）。结论AUM较CUD能更容易监测到患者SUI和DO的发生，SUI阳性率增高可能与AUM组患者ALPP值偏低有关。对于有临床症状而CUD检查未见明显异常的患者，可以进一步行AUM检查，降低SUI和DO的漏诊率。

Objective To compare the application of ambulatory urodynamie （AUM） and conven- tional urodynamic （CUD） in detecting stress urinary incontinence （SUI） and detrusor overactivity （DO） in females. Methods Incontinence questionnaire short form （ICI-Q-SF） , CUD and AUM were administra- ted on 30 female patients with the mean age of 49.4 （32 - 63） years. The duration of symptom was 4.7 （1 -9） years. The patients were divided into 3 groups of mild （n =9）, moderate （n = 15） and severe （n = 6） according to ICI-Q-SF. Three mieturition cycles were recorded during AUM. Results SU] and DO detected by AUM were 90% and 37% , significantly more than those by CUD of 70% and 10% （P 〈 0.05）. Twenty-one moderate and severe SUI patients diagnosed by ICI-Q-SF, detected by AUM and CUD simultaneously showed that abdominal leak point pressure （ALPP） and voided volume were lower, and de- trusor pressure was higher recorded by AUM than those by CUD significantly （ P 〈 0.05 ）. Conclusions SUI and DO are easier detected by AUM than by CUD. AUM is a useful additional tool in clinical practice for those patients CUD failed to explain their symptoms.