目的 探讨从功能学和形态学两个方面探讨不同性别各种复杂性下尿路排尿功能障碍患者的影像尿动力学特点及行影像尿动力学检查的应用价值。方法 2009年5月~2012年6月因各种复杂性下尿路排尿功能障碍在我院行影像尿动力检查(VUDS)患者78例, 其中男性38例, 女性40例;患者年龄19~75岁, 平均47岁, 均以各种LUTS症状为主诉, 合并解剖异常或其他慢性神经系统疾病史, 或有手术失败史拟行进一步手术治疗。采用Laborie公司生产的尿动力学分析仪和SIEMENS公司生产的数字化X线检查手术床对患者进行全面VUDS检查(包括自由尿流率测定、充盈期CMG、排尿期PFS和同步影像显像, UPP测定)。结果 78例患者中有4例因膀胱测压管置入困难而终止VUDS检查(均为男性), 剩余74例中神经源性膀胱8例(脊柱术后、脑梗后或帕金森氏病等), 其中DU3例, DO 2例, 低顺应性膀胱合并肾积水2例, DESD 1例。非神经源性排尿功能障碍59例, 其中BOO 29例(包括BPO 3例, POP 5例, 膀胱颈部梗阻13例, 后尿道梗阻3例, 失调性排尿5例), DU 13例(8例女性患者有5例因无法排尿未行PFS测定), DO3例, 真性尿失禁4例, 前列腺术后压力性尿失禁10例。各项指标均正常7例。8例患者行VUDS检查后改变原临床诊断。结论 影像尿动力学检查对复杂性下尿路排尿功能障碍患者的诊断具有重要意义, 能更精确地了解患者逼尿肌、尿道括约肌功能和解剖异常部位, 并对下尿路病变的部位和程度做出定性定位诊断和相应分类, 为下一步治疗提供了可靠依据。
Objective To investigate the videourodynamic study(VUDS) characteristics of various complex lower urinary tract voiding dysfunction and the diagnostic value of videourodynamic examination.Methods From May 2009 to June 2012,78 patients with complex lower urinary tract voiding dysfunction were included in our study.There were 38 males and 40 females,aged 19-75(mean,47) years.All patients had chief complaints of various lower urinary tract symptoms(LUTS),accompanying anatomical abnormalities or other chronic nervous system diseases history,or had a history of failed surgery planning for further surgery treatments.All patients underwent thorough VUDS(uroflowmetry,cystometrogram,pressure-flow study and urethral pressure profile).Results 4 males were removed who couldn’t be intubated the bladder pressure catheter.The remaining 74 cases underwent complete VUDS.8 cases were neurogenic bladder,including DU (3 cases),DO (2 cases),bladder low compliance with uronephrosis(2 cases) and DESD (1 cases).59 cases were non-neurogenic voding dysfunction,including BOO (29 cases),DU (13cases,with 5 female patients who couldn’t void voluntarily in PFS),DO (3 cases),real urinary incontinence(4 cases),stress urinary incontinence after prostatectomy(10 cases).BOO were classified into BPO (3 cases),POP (5 case),bladder neck obstruction (13 cases),posterior urethral obstruction (3 cases) and dysfunctional voiding(5 cases).7 cases were diagnosed normal in VUDS.8 cases changed their previous clinic diagnosis after VUDS.Conclusion Videourodynamic examination provides precise evidence of diagnosis for complex lower urinary tract voiding dysfunction.It can evaluate anatomic abnormalities sites and the function of detrusor/urethral sphincter.It also provides preliminary classification of lower urinary tract diseases and reliable references for the following treatments.
[1] 1 Schofer W,Abrams P,Liao L,et al.Good urodynamic practices: uroflowmetry,filling cystometry,and pressure-flow studies[J].Neurourol Urodyn,2002,21(3):261-274.
[2] Abrams P,Cardozo L,Fall M,et al,The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society[J].Urology,2003,61(1):37-49.
[3] van Mastrigt R,Griffiths DJ.ICS standard for digital exchange of urodynamic study data[J].Neurourol Urodyn,2004,23(3):280-281.
[4] Kuo HC.Videourodynamic analysis of pathophysiology of men with both storage and voiding lower urinary tract symptoms[J].Urology,2007,70(2):272-276.
[5] 金锡御,宋波.临床尿动力学[M].北京:人民卫生出版社,2002:128-145.
[6] 吴新华,陈敏,陈朝晖,等.下尿路排尿功能障碍患者的影像尿动力学评估[J].临床泌尿外科杂志,2006,21(3):203-205.
[7] 鞠彦合,廖利民,李东,等.神经源性膀胱尿道功能障碍患者的影像尿动力学研究[J].中华外科杂志,2008,46(20):1525-1528.
[8] 张鹏,武治津,杨勇.影像尿动力检查在下尿路排尿障碍疾病诊断中的作用[J].中华外科杂志,2010,48(17):1321-1324.
[9] 张鹏,武治津,杨勇,等.影像尿动力学检查在诊断女性下尿路排尿功能障碍疾病中的应用[J].中华外科杂志,2012,50(5):438-442.
[10] Bosch JL,Cardozo L,Hashim H,et al.Constructing Trials to Show Whether Urodynamic Studies Are Necessary in Lower Urinary Tract Dysfunction[J].Neurourol Urodyn,2011,30(5): 735-740.
[11] Jerry Blaivs,Michael B,Chancellor Jeffrey Weiss,et al(原著),吴士良(主译).尿动力学图谱[M].第2版.北京:人民卫生出版社,2008:107-129.
[12] Akikwala TV,Fleischman N,Nitti VW.Comparison of diagnostic criteria for female bladder outlet obstruction[J].J Urol,2006,176(5): 2093-2097.
[13] Goldman HB,Zimmern PE.The treatment of female bladder outlet obstruction[J].BJU Int,2006,98(Suppl 1):17-23.
[14] Kaufman MR,Scarpero H,Dmochowski RR.Diagnosis and management of outlet obstruction in the female[J].Curr opin Urol,2008,18(4): 365-369.
[15] Blaivas JG,Female lower urinary tract symptoms: pharmacotherapeutic consequence[J],BJU Int,2000,86 (Suppl 2): 1-10.
