女性下尿路症状临床诊治策略

Strategy of clinical diagnosis and treatment in women with lower urinary tract symptoms

下尿路症状（LUTS）是女性常见疾病,其病因、临床表现、诊治方法与男性有很大不同,详细询问病史,体检和尿常规检查是诊治中必不可少的步骤.彻底治疗下尿路感染在女性尿频的治疗中非常重要,液体摄入管理、行为治疗联合药物治疗对改善患者症状、提高生活质量很有帮助.顽固性膀胱过度活动症采取骶神经调节治疗具有良好效果.逼尿肌活动低下是女性排尿期症状的常见原因,目前对其发病机制知之甚少.女性膀胱出口梗阻分为解剖性和功能性梗阻两类,尚缺乏统一的尿动力学诊断标准,不同类型梗阻的病因不同,治疗方法各异,重要的是找出梗阻的病因,正确诊断是治疗成功的关键.

Lower urinary tract symptoms （LUTS） are common in women.The etiology,clinical manifestation,diagnosis and management of LUTS in women are different from those in men.A detailed history,a physical examination and a urine analysis are essential components of the initial evaluation of lower urinary tract symptoms in the female.Thoroughly treating urinary tract infection is very important in management of frequency.In addition,management of fluid intake,behavioral and drug therapies are often used in combination to optimize patient symptom and the quality of life.Intravesical injection of onabotulinumtoxinA is highly effective,but often requires repeated treatments.Sacral neuromodulation is an effective,minimally invasive surgical treatment for refractory overactive bladder in carefully selected,cognitively capable patients.Detrusor underactivity is a common cause of LUTS in women.Female bladder outlet obstruction was divided into two categories,anatomical and functional obstruction.So far,there is no uniform urodynamic standard for diagnosing bladder outlet obstruction in women.The clinical manifestations are various in different types of obstruction,so is the management.It is important to find out the causes of obstruction,and only in this way can we get correct diagnosis,thus treating patients successfully.