女性顽固性下尿路症状患者的脊髓神经系统异常及其病因学意义

The abnormalities demonstrated by spine MRI indicate the possibility of etiology for refractory lower urinary tract symptoms in female patients

目的探讨女性顽固性下尿路症状（LUTS）患者的脊髓神经系统异常及其病因学意义。方法前瞻性收集2017年1-3月在同一名尿控专业主任医师专家门诊就诊的全部女性LUTS患者的病例资料，包括人口学信息、主诉、现病史、既往史、体格检查、尿常规检查、泌尿系超声检查等信息。将常规治疗〉3个月无效的顽固性LUTS患者纳入本研究，排除有明显尿路感染、尿路肿瘤、泌尿系结石、中枢神经系统疾病、各种外伤、泌尿生殖系统手术史的患者，以及按现有医学常识判断可能影响下尿路功能的其他已知疾病和情况。纳入研究的患者均行尿动力学检查和颈胸腰骶椎MRI检查。分析患者的临床特点、尿动力学特征和脊髓神经系统MRI的病变特点。结果本研究共纳入70例病史资料完整，且同时完成尿动力学检查和颈胸腰骶椎MRI检查的患者，其中伴有储尿期症状63例（90．9％）、排尿期症状11例（15．7％）、排尿后症状8例（11．4％）、大便异常12例（17．1％）、下腹或盆部疼痛45例（64．3％）。尿动力学检查各项指标均正常1例（1．4％）；异常69例（98．6％），其中膀胱感觉过敏33例（47．1％）、膀胱容量减少12例（17．1％）、逼尿肌无抑制收缩16例（22．9％）、下尿路梗阻15例（21．4％）、逼尿肌活动低下39例（55．7％）。颈胸腰骶椎MRI检查未见异常1例（1．4％）；发现异常69例（98．6％），其中骶神经病变54例（77．1％）、颈椎病变49例（70．0％）、腰椎问盘病变48例（68．6％）、胸椎病变4例（5．7％）；56例（80．0％）同时存在≥2个区段病变。结论女性顽固性LUTS患者普遍存在的尿动力学检查参数异常，提示下尿路功能障碍是其症状发生的病理生理学基础；极高的脊髓神经系统病变患病率提示其极有可能是顽固性LUTS的潜在病因。

Objective To approach the spine MRI features and its possibility of etiology for refractory lower urinary tract symptoms（LUTS） in female patients. Methods We conducted prospectively a cross sectional description study of female patients with refractory LUTS during January 16 through March 27 in 2017 based on a urologist＇ s outpatient work. The including criteria were adult female patients with refractory LUTS which defined as having LUTS more than three months and having poor response to behavior therapy and medication treatment. The excluding criteria were patients having evidence of infection, tumor, stone in urinary tract, any central nerve system diseases, or any other diseases may potentially producing LUTS. Data collected included patients demographic information,main complains,present disease features, disease history, physical examination ,urine routine, urodynamie study and spine MRI. The characteristics of clinical manifestation ,urodynamic study and spine MRI were analyzed. Results During the time span of study ,totally 70 cases had been diagnosed as having refractory LUTS and had qualified data of clinical recordings,urodynamie study and spine MRI. Among these 70 cases, 63 （90. 9% ） had storage phase symptoms, 11 （ 15. 7% ） had voiding phase symptoms, 8 （ 11. 4% ） had postmicturition symptoms, 12 （17. 1% ） also had disorders in defecating,45 （64.3%） had pain in lower abdomen or pelvic region. 69 eases （98.6%）had urodynamie disorders, 33 （47.1%） had oversensitivity of bladder, 12 （17. 1% ） had smaller bladder volume, 16 （ 22.9% ） had detrusor overactivity, 15 （ 21.4% ） had bladder outlet obstruction, 39 （55.7%） had detrusor underaetivity. 69 cases （98.6%） had spine MRI abnormalities,54 （77.1% ） had sacral nerve lesions, 49 （ 70.0% ） had cervical lesions, 48 （ 68.6% ） had lumbar lesions, 4 had thorathie lesions. Conclusions The present study revealed extraordinary high prevalence of abnormality in urodynamie parameters and spine MRI in female patients with refractory LUTS, which implies possibility that the refractory LUTS are caused by lesions in spinal nerve system.