膀胱尿道压力同步测定评估女性压力性尿失禁的临床分析

Bladder and urethra synchronous manometry in assessment of female stress urinary incontinence

目的探讨膀胱尿道压力同步测定评估女性压力性尿失禁的应用价值。方法选取35例女性压力性尿失禁(stress urinary incontinence,SUI)患者,年龄(49.5±8.6)岁,同时选取34例排尿功能正常的女性患者(48.4±10.3)岁作为对照组。根据国际尿控协会规定的尿动力检查方法采用MMS尿动力检查仪对两组患者进行膀胱尿道压力同步测定。观察参数包括:充盈期尿道闭合压(filling urethral closure pressure,UCPfill)、Valsaval动作时尿道闭合压(urethral close pressure,UCP)、腹压传导率(pressure transmission ratio,PTR)、最大尿流率时的尿道闭合压(voiding urethral close pressure,UCPvoid)。结果两组患者充盈过程中未增加腹压时尿道闭合压为正值,且充盈期前和充盈期末UCPfill没有明显改变(P>0.05),但SUI组UCPfill明显低于对照组(P<0.05)。行Valsaval动作时,SUI组尿道闭合压降为负值且腹压传导率≤100%,而对照组尿道闭合压仍保持正值,腹压传导率大于100%,两组UCP和PTR差异均有统计学意义(P<0.05)。排尿期SUI组和对照组膀胱压升高,尿道压同步降低,最大尿道闭合压为负值,两组间UCPvoid无明显差异(P>0.05)。结论膀胱尿道压力同步测定是判断膀胱尿道协调功能的有效方法。SUI患者膀胱充盈期尿道闭合压低、增加腹压时尿道闭合压为负值和腹压传导率≤100%可以作为提示发生压力性尿失禁的客观依据。

Objective To explore the application of bladder and urethra synchronous manometry （BUSM） in the assessment of female stress urinary incontinence （SUI）. Methods Thirty-five women （49. 5 ±8.6 years old） diagnosed with SUI were included in the SUI group, and thirty-four women without voiding dysfunction （48.4±10.3 years old） were selected as the control group （NSUI group）. BUSM was carried out in all women according to the standards proposed by the International Continence Society. The observation parameters included filling urethral closure pressure （UCPfill）, average urethral closure pressure （UCP） in valsaval maneuver, pressure transmission ratio （PRT）, and voiding urethral closure pressure （UCPvoid）. Results During the filling process, the static urethral pressure was higher than bladder pressure in the SUI and NSUI groups, and there was no change in UCPfill at the beginning and at last （P 〉0.05）, however, the UCPfill of the SUI group was obviously lower than that of the NSUI group （P 〈0.05）. When the patients did valsaval maneuver, the UCP was negative and PTR was 100% or less in the SUI group, while the UCP remained positive and PRT was greater than 100% in the NSUI group, and the UCP and PTR between the SUI and NSUI groups had statistical significance （P 〈 0. 05）. In the voiding phase, the bladder pressure increased while urethral pressure decreased, and the maximal urethral closure pressure was negative, but there was no difference in UCPvoid between the SUI and NSUI groups （P 〉0.05）. Conclusion BUSM is an effective measurement to assess the coordination function of the bladder and urethra. The lower UCPfill, PRT≤100% and negative UCP can provide valuable references for diagnosis of SUI.