239例下尿路排尿功能障碍患者影像尿动力学特点分析

Analysis of imaging urodynamic characteristics in 239 patients with lower urinary tract voiding dysfunction

目的回顾分析我科下尿路排尿功能障碍患者影像尿动力学诊断特点,探讨影像尿动力学在复杂排尿功能障碍患者诊断中的优势。方法收集自2014年1-7月因下尿路排尿功能障碍而在我科行影像尿动力检查患者239例,男性165例,女性74例。分析神经源性膀胱和非神经源性膀胱患者尿动力学诊断特点及下尿路影像形态,探讨典型复杂排尿功能障碍患者尿动力学检查的特点及输尿管、膀胱、尿道形态学的变化。结果 239例患者中因存在明确神经系统病变而出现排尿功能障碍经尿动力学检查确定为神经源性膀胱患者32例(13.39%):1逼尿肌反射亢进伴急迫性尿失禁8例,3例患者存在脑血管意外,1例患者存在帕金森病,2例患者存在阿尔茨海默病,1例患者存在骶脊膜膨出;1例患者行根治性子宫全切。2逼尿肌收缩无力伴尿性尿潴留24例,其中糖尿病患者16例,急性感染性多发性神经根炎患者2例,酗酒患者2例,药物滥用患者1例,高空坠落致腰或骶髓损伤3例。存在单侧输尿管反流1例,双侧输尿管反流7例,逼尿肌膀胱颈协同失调2例,逼尿肌尿道外括约肌协同失调3例。诊断为非神经源性膀胱患者203例(84.94%):膀胱出口梗阻131例、压力性尿失禁41例、单纯逼尿肌过度活动11例、逼尿肌收缩力弱10例、逼尿肌收缩无力10例。排尿期膀胱颈部完全开放76例,部分开放129例,膀胱颈部未见开放34例。膀胱及尿道功能未见异常4例(1.67%)。结论影像尿动力检查可帮助神经源性膀胱患者准确判断是否存在逼尿肌-尿道外括约肌协同失调、逼尿肌-膀胱颈协同失调、输尿管反流、漏尿点压,对于非神经源性膀胱患者,可帮助判断胱和尿道的影像形态变化,精确了解尿道梗阻部位,甚至了解膀胱尿道是否存在异物。

Objective To review and analyze the diagnostic characteristics of urinary voiding dysfunction in patients undergoing imaging urodynamic examination, and to explore the advantage of imaging urodynamic diagnosis in complicated voiding dysfunction. Methods Data were collected from 239 patients （165 males and 74 females）, who underwent imaging urodynamic examination due to lower urinary tract voiding dysfunction in our department from January 2014 to July 2014. All patients were examined by the same urodynamic clinician according to the Urodynamic Operations Guide of the Chinese Urological Association （2010 edition）. The diagnostic characteristics of neurogenic or non-neurogenic bladder urodynamics and lower urinary tract imaging were analyzed, and the characteristics of typical complicated voiding dysfunction and the morphological changes of the ureter, bladder and urethra were observed. Results Of 239 patients with nervous disease and voiding dysfunction, 32 patients （13.39%） with neurogenic bladder were diagnosed by imaging urodynamics, and there were 8 patients with detrusor hvoerreflexia and urge incontinence. 3 with cerebrovascular accident, 1 with Parkinson＇ s disease, 2 with Alzheimer＇ s disease, 1 with sacral spina bifida and 1 with radical hysterectomy. Twenty-four patients were diagnosed with detrusor weakness and urinary retention, and among them, there were 16 patients with diabetes, 2 with acute infectious polyneuritis, 2 with alcoholism, 1 with drug abuse, and 3 with falling-caused back or sacral spinal cord injury. Also, urodynamic images indicated 1 patient with unilateral ureteral reflux, 7 with bilateral ureteral reflux, 2 with detrusor- bladder neck dyssynergia and 3 with detrusor-external sphincter dyssynergia. Of 203 patients （84.94%） diagnosed with non-neurogenic bladder by imaging urodynamics, there were 131 patients with bladder outlet obstruction, 41 with detrusor contractility, opened after voiding, opened. In addition, pressure urinary incontinence, 11 with simple detrusor overactivity, 10 with weak and 10 with acontractile detrusor. There were 76 patients with bladder neck completely 129 patients with bladder neck partially opened, and 34 patients without bladder neck the function of bladder and urethral was diagnosed as normal in 4 patients （ 1.67 % ）. Conclusion Imaging urodynamic examination can help the clinicians to improve the diagnosis of detrusor- external urethral sphincter dyssynergia, detrusor-bladder neck dyssynergia, vesicoureteral reflux, and leak point pressure in patients with neurogenic bladder, and improve the diagnosis of the shape changes of bladder and urethra, urethral obstruction site and any foreign bodies in patients with non-neurogenic bladder.