女性下尿路症状患者的尿动力学分析

Urodynamic analysis of the female lower urinary tract symptoms

目的 探讨女性下尿路症状原因及临床意义。 方法 72例下尿路症状女性患者 ,年龄 8～ 86岁 ,平均 4 8岁。其中排尿困难 4 6例 ,尿失禁 14例 ,尿频 10例 ,夜间遗尿 2例。患者均行尿动力学检测。 结果 4 6例排尿困难者膀胱容量 6 0～ 80 0ml,其中 2 0例膀胱逼尿肌收缩力为 0 ,2 6例9～ 16 0cmH2 O(1cmH2 O =0 .0 98kPa)。Linp URR图示为Ⅲ级以上梗阻者 19例。尿道静态分布阻力2 5～ 130cmH2 O。膀胱逼尿肌与尿道外括约肌协调性良好者 5例 ,协同失调者 33例。 10例尿频患者膀胱容量 97～ 4 5 0ml,2例排尿期膀胱逼尿肌收缩力为 0 ,8例 31～ 110cmH2 O。Linp URR图示显示Ⅲ级以上梗阻者 2例。 1例急迫性尿失禁者膀胱过度敏感。 6例压力性尿失禁者腹压漏尿点压力 4 4～76cmH2 O。 3例充盈性尿失禁者排尿期膀胱逼尿肌压力为 0 ,尿道静态分布阻力 32～ 4 2cmH2 O。真性尿失禁 4例尿道外括约肌压力 0～ 16cmH2 O ,平均 (8.5± 5 .7)cmH2 O。 2例遗尿患者存在不稳定性膀胱表现 ,排尿期膀胱收缩乏力。 结论 尿动力学检查对女性下尿路症状疾病诊断、治疗、预后判断具有重要指导意义。

Objective To investigate the causes and the clinical significance of the female lower urinary tract symptoms (LUTS). Methods Of the 72 female patients (mean age,48 years;range,8 to 86 years) with LUTS,46 had dysuria,14 with incontinence,10 with frequency and urgency of micturition and 2 with nocturnal enuresis.Urodynamic examinations were conducted in these patients. Results Among the 46 cases with difficulty of urination,whose bladder volumes were 60 to 800 ml,20 had the bladder detrusor contractility of 0,and 26,of 9 to 160 cm H 2O.Linearised passive urethral resistance relation (Linp-URR) figure showed at least grade Ⅲ obstruction in 19 cases.The urethral pressure profiles (UPPs) were 25 to 130 cm H 2O.Dyssynergia of detrusor-external sphincter occurred in 33 cases with voiding dysfunction.Ten cases with frequency of micturition had bladder volume of 97 to 450 ml.Two cases had the bladder detrusor contractility of 0,the other 8 cases were of 9 to 160 cm H 2O.Linp-URR figure showed at least grade Ⅲ obstruction in 2 cases.One case with urgent incontinence had hyper-sensitive bladder.The abdominal leak point pressures were 44 to 76 cm H 2O in 6 cases of stress incontinence.3 cases of overflowing urinary incontinence had no contraction of bladder detrusor and the UPPs were 32 to 42 cm H 2O.The UPPs were 0 to 16 cm H 2O in the 4 cases of total urinary incontinence.Two cases of nocturnal enuresis had detrusor instability with impaired contractility. Conclusions Urodynamic examination is necessary to the diagnosis of female LUTS and it also has significant value in predicting the treatment and prognosis of LUTS.