不明原因顽固性尿频伴尿失禁诊治经验及文献复习

Diagnosis and treatment of refractory urinary frequency and incontinence and literature review

目的分析1例无明显诱因出现顽固性尿频及尿失禁表现的青年男性的临床资料,探讨该类患者的病因学及诊治思路。方法对我院2017年6月收治的1例以顽固性尿频、尿失禁和排便困难为主要表现的青年男性的临床资料进行回顾性总结,分析其诊断过程、手术情况及术后病理,并随访术后病情恢复情况,总结探讨诊治经验并对相关文献进行复习。结果患者表现为不明原因顽固性尿频3年,日间排尿20~30次,夜尿10次,近2年出现显著急迫性尿失禁症状,近3个月上述症状进行性加重伴排便困难。曾反复就诊于多家医院均未能明确诊断,多种对症治疗药物治疗无效。于我院门诊查体提示:鞍区感觉减退、提睾反射减弱及肛门括约肌收缩无力,遂行脊柱磁共振检查,结果发现明确的腰椎椎管内占位,并行手术切除,术后病理证实为腰椎管内皮样囊肿。术后6个月随访,患者肛门括约肌收缩力恢复正常,排便困难症状消失,尿频症状明显缓解,日间排尿7~9次/d,夜尿2~3次/晚,尿意感觉明显,尿失禁症状消失。结论对于不明原因顽固性尿频伴尿失禁的患者,不能局限于本专业本系统疾病进行考虑,需进行多系统综合分析,细致全面体检及辅助检查中的细微信息都是早期做出正确诊断的必要条件。

Objective To analyze the clinical data of a young male with symptoms of severe refractory urinary frequency and incontinence without obvious incentive, and summarize and investigate the diagnosis and management of this type patient. Methods The clinical data of a young man with refractory urinary frequency, incontinence and defecation difficulty who was treated in our hospital in June 2017 were summarized and analyzed in this study. His diagnosis process, operation, post-operative pathological results and conditions during follow-up were collected and analyzed. Our experiences of his diagnosis and treatment were summarized in combination with relevant literatures. Results The patient had suffered from unexplained refractory urinary frequency for 3 years, with a urination frequency of 20 - 30 times in the day and 10 times during the night. The symptom of significant urge incontinence appeared in recent 2 years, and all these symptoms were progressively aggravated in addition with difficulty in defecation in the past 3 months. He had been to many hospitals and received a variety of symptomatic treatment, but his condition had not improved. Medical examination in the outpatient department of our hospital showed saddle paresthesia, weakness of cremasteric reflex and contractile weakness of anal sphincter constriction. Then spinal magnetic resonance imaging displayed an intraspinal space-occupying lesion in the lumbar vertebra, which was resected surgically and proved to be a lumbar endothdid cyst by postoperative pathology, In 6 months of follow-up, the contractile force of the anal sphincter returned to normal, the symptom of defecation was disappeared, and penile erectile function was normal as before. The urinary frequency was significantly alleviated to 7 - 9 times in the day and 2 - 3 times during the night. The sensation of urination returned to normal, and urinary incontinence was disappeared. Conclusion For the diagnosis of the patients with unexplained refractory urinary frequency and incontinence, it is necessary to carry out a comprehensive analysis to multiple systems. Detailed physical examination and subtle information in the auxiliary examination are prerequisite for early correct diagnosis.