女性压力性尿失禁合并膀胱颈梗阻的临床特点及治疗

Clinical characteristics and treatment of female stress urinary incontinence combined with bladder neck obstruction

目的分析女性压力性尿失禁(SUI)合并膀胱颈梗阻(BNO)的临床特点和治疗。方法回顾性分析2013年11月至2018年4月17例于北京朝阳医院泌尿外科住院的女性SUI合并BNO患者临床资料,患者均Ⅰ期行膀胱颈电切术,Ⅱ期行耻骨后尿道中段吊带术。统计分析患者的临床特征、手术疗效和预后。结果共纳入17例患者,年龄(60.3±2.6)岁,体质指数(23.8±0.5)kg/m2。与术前相比,膀胱颈电切术后的最大尿流率显著增加[(9.3±0.5)ml/s比(25.6±0.8)ml/s,P<0.001],残余尿和峰值尿流率逼尿肌压均显著下降[(167.5±4.4)ml比(4.1±0.5)ml,P<0.001;(49.4±1.3)cmH2O比(24.9±0.7)cmH2O,P<0.001]。Ⅱ期耻骨后尿道中段吊带术后的尿失禁问卷表简表评分显著低于膀胱颈电切术后[(2.4±0.4)分比(14.9±0.3)分,P<0.001]。耻骨后尿道中段吊带术后主客观治愈例数为13例,余4例患者治疗结果为改善。膀胱颈电切术和耻骨后尿道中段吊带术的住院时间[(5.6±0.5)d比(3.4±0.2)d]和手术时间[(25.6±1.4)min比(42.9±2.9)min]均较短。17例患者术中均未出现并发症,2例耻骨后尿道中段吊带术后出现排尿困难,1例出现腹股沟区疼痛。结论女性SUI合并BNO患者主要为中老年、肥胖人群,Ⅰ期行膀胱颈电切术和Ⅱ期行耻骨后尿道中段吊带术的有效性和安全性高,可有效解除梗阻并提高患者生活质量。

Objective To analyze the clinical characteristics and treatment of female stress urinary incontinence (SUI) combined with bladder neck obstruction (BNO). Methods The clinical data of 17 cases of female SUI patients with BNO, who was admitted to the Urology department, Beijing Chaoyang hospital from November 2011 to April 2018, were retrospectively analyzed. The mean age was (60.3±2.6) years old and the mean body mass index was (23.8±0.5) kg/m2. All patients had the first stage bladder neck incision with the second stage suprapubic urethral support sling. The clinical characteristics, curative effects and outcomes were analyzed. Results The maximum flow rate was increased significantly after the bladder neck incision compared with preoperative [(9.3±0.5) vs (25.6±0.8) ml/s, P<0.001]. The postvoid residual urine volume and PdetQmax were decreased significantly than that preoperative [(167.5±4.4) vs (4.1±0.5) ml, P<0.001;(49.4±1.3) vs (24.9±0.7) cmH2O, P<0.001]. The incontinence questionnaire-short form score was significantly lower after the second stage suprapubic urethral support sling [(2.4±0.4) vs (14.9±0.3), P<0.001]. The number of subjective and objective case of suprapubic urethral support sling was 13, and the treatment effect of other patients was improved. The hospitalization and operation time of the bladder neck incision and the suprapubic urethral support sling were short. All patients had no intraoperative complications, two cases had dysuria and one case had groin pain after the suprapubic urethral support sling operation. Conclusions The patients of female SUI combined with BNO are most elderly and obese population. The effectiveness and safety of the first stage bladder neck incision and the second stage suprapubic urethral support sling are high, and the surgeries can effectively relieve the obstruction and improve the quality of patients′life.