生物反馈联合盆底电刺激疗法治疗压力性尿失禁的疗效分析

目的探讨生物反馈＋盆底电刺激疗法对压力性尿失禁的治疗效果、影响疗效及复发的相关因素以及预后评价。方法46例压力性尿失禁患者根据治疗意向随机进入前瞻性研究，其中绝经前患者19例，绝经患者27例。应用生物反馈＋盆底电刺激治疗仪进行治疗，随访观察治疗效果。结果46例中43例治疗有效，总有效率为93％，每次治疗平均时间为40min。绝经前患者治疗4—30次，平均10次，显效时间为第1—10次，平均为第3．6次；绝经患者治疗6—30次，平均9．8次，显效时间为第1—10次，平均为第4．2次；不同体重指数（〈24或≥24kg／m^2）和尿失禁程度（轻、中、重）者治疗次数存在差异，但对疗效无显著性影响（P〉0．05）。治疗后随访3—22个月，40例有完整随访资料，失访6例，9例患者治愈，4例生物反馈＋盆底电刺激治疗有效者仍选择手术治疗，3例患者复发，复发患者主动接受再次生物反馈＋盆底电刺激治疗，仍然有效。结论生物反馈＋盆底电刺激疗法能够有效治疗压力性尿失禁，绝经与否，体重指数以及尿失禁程度均不影响疗效。     

经阴道无张力尿道悬吊术治疗女性压力性尿失禁40例分析

目的：观察经阴道无张力尿道悬吊术(TVT)治疗女性压力性尿失禁的临床疗效。方法：2001年10月至2003年1月采用经阴道无张力尿道悬吊术治疗40例女性压力性尿失禁。结果：40例手术后尿失禁均得到控制，经随访2—26个月无一例出现尿失禁现象。平均手术时间54min，平均出血量80mL。40例患者恢复正常排尿后到残余尿均＜50mL。结论：TVT手术治疗女性压力性尿失禁具有手术创伤小、在局麻下手术、吊带悬吊效果可靠、作用持久、手术悬吊适度、手术并发症发生率低等优点，适宜临床推广应用。     

绝经后妇女尿失禁的病因及治疗

女性尿失禁是绝经后妇女常见病,其发生率据文献报道为５％～４３％不等,这可能是由于研究人群及定义不同所致,一些研究表明相当部分的尿失禁在绝经期发生或恶化。随着妇女平均寿命延长,妇女可望活到８０～９０岁,大多数妇女一生中超过１／３时间在绝经后期,绝经后妇女尿失禁问题引起妇产科学者关注。１　绝经后妇女常见尿失禁类型根据国际控制学会（ＩＣＳ）定义,尿失禁（ｕｒｉｎａｒｙｉｎｃｏｎｔｉｎｅｎｃｅ,ＵＩ）为不自觉的尿液漏出,它是一个社会、卫生问题,并且可以客观地检测出来。主要分类：①真性压力性尿失禁（ｇｅ…     

女性压力性尿失禁手术治疗的发展进程及术式评价

尿失禁（urinary incontinence，UI）是女性常见病，绝大部分是压力性尿失禁（stress urinary incontinence，SUI），其发病率各国报道不一，大约在8％～54％之间不等。据我国少数几个城市报道发病率在40％左右。就尿失禁发病机制而言，最初1961年Enhorning压力传导理论认为尿失禁的发生如同自然界水往低处流是因为存在压差，液体流动的规律是从高压向低压处流动，各种尿失禁的共同特征都是膀胱压力大于尿道压力。     

绝经后子宫出血150例临床及病理分析

目的探讨绝经后子宫出血的原因与子宫内膜癌的关系。方法对150例绝经后子宫出血诊断性刮宫(诊刮)后的子宫内膜进行病理分析。结果功能性子宫出血130例(占86．67％)，其中萎缩性子宫内膜60例(占46．15％)，增生期子宫内膜53例(占40．77％)，分泌期子宫内膜17例(占13．08％，)。子宫内膜癌12例(占8．00％．)，子宫内膜炎8例(占5．33％)。结论随着绝经时间的延长和绝经年龄的后延，发生子宫内膜癌的比例升高。     

超声尿动力学检查在女性压力性尿失禁手术前后的临床意义

目的 探讨女性压力性尿失禁手术前后的超声尿动力学的变化、临床意义。方法 对15例患有中重度的压力性尿失禁的女性患者，分别进行尿失禁的常规检查，超声尿动力学检查。应用不同的手术方法进行压力性尿失禁手术，如进行复合医用材料悬吊术，包括：In-fast Sling7例、TVT手术3例、Sparc 2例；还有耻骨上膀胱颈尿道悬吊术(Butch)3例。术后再次进行相应的检查。结果 经过各种不同的手术，压力性尿失禁的症状均得到缓解，有12例各项指标恢复或改善，3例检查指标无明显变化，但症状缓解。结论 超声尿动力学检查在女性压力性尿失禁的诊断、治疗方法的选择、术后的随访等方面有着重要的意义。     

经耻骨后与经闭孔无张力尿道悬吊术治疗女性压力性尿失禁并发症分析

目的比较经耻骨后无张力尿道悬吊术（TVT）和经闭孔无张力尿道悬吊术（TVT—O）治疗女性压力性尿失禁的手术并发症。方法回顾性分析我院2002年9月-2007年6月应用TVT和TVT—O治疗女性压力性尿失禁患者167例（TVT术74例,TVT-O术93例）的临床资料。结果术中膀胱穿孔：TVT组发生率为9．46％,TVT—O组为1．08％（P〈0．05）;术中出血〉100ml：TVT组发生率为16．22％,TVT—O组6．45％（P〈0．05）,其他术中、术后并发症发生率两种手术方法比较,差异无显著性（P〉0．05）。结论与TVT比较,TVT-O手术并发症的发生率低,且手术操作简便、手术时间短,是一种较理想的治疗女性压力性尿失禁的手术方法。     

两种经闭孔无张力尿道悬吊术治疗压力性尿失禁疗效对比研究

目的回顾性评估由外向内经闭孔无张力尿道悬吊术（‘outside-in’ transobturator tape,TOT）与由内向外经闭孔无张力尿道悬吊术（‘inside—out’ transobturator tape,TVT-O）治疗压力性尿失禁的安全性和有效性。方法选择2004年4月～2007年1月本院压力性尿失禁患者79例,其中,行TOT患者41例,行TVT-O患者38例。TOT组和TVT-O组患有混合性尿失禁者分别为17例和13例;伴有盆腔脏器脱垂者9例和7例。对比两种手术方式的治愈率和术后并发症,评估两者的安全性和有效性。结果单纯性尿失禁患者平均手术时间为11min（TOT）和15min（TVT-O）。TVT—O组发生膀胱穿孔1例。TOT组平均随访时间为26个月,TVT-O组为14个月。TVT-O组和TOT组的1年总治愈率分别为92％和90％（P〉0．05）。结论TOT和TVT-O均能有效的治疗伴有或不伴有盆腔器官脱垂的压力性尿失禁。     

延迟可吸收吊带与永久非吸收吊带治疗女性压力性尿失禁的疗效比较

目的探讨延迟可吸收吊带和永久非吸收吊带治疗女性压力性尿失禁的临床疗效及适宜的抗尿失禁手术材料。方法对2010年2月至2011年8月因压力性尿失禁在北京大学人民医院妇科进行手术治疗的51例患者的临床资料进行回顾性分析,其中研究组23例,采用延迟可吸收吊带;对照组28例,采用永久非吸收吊带。比较两组患者的手术情况、术后留置尿管时间及术后残余尿量,并采用尿失禁影响程度相关问卷（IIQ-7）和泌尿生殖道疾病相关问卷（UDI-6）评价手术疗效。结果两组患者的年龄、绝经时间、产次、病程、术前1h尿垫试验比较,差异均无统计学意义（P〉O．05）;两组患者的手术时间、术中出血量、术后留置尿管时间和术后残余尿量比较,差异均无统计学意义（P〉O．05）;研究组术后平均随访时间为（10．5±5．7）个月,对照组术后平均随访时间为（11．8±7．6）个月,两组患者主观治愈率分别为73．9％（17／23）和71．4％（20／28）,有效率分别为100．O％（23／23）和96．4％（27／28）,两组比较,差异均无统计学意义（P〉O．05）。两组均无吊带侵蚀等并发症。结论无论是延迟可吸收吊带还是永久非吸收吊带,治疗压力性尿失禁有相同的近期疗效,短期内未见吊带侵蚀,可能与本文随访时间短,手术例数少有关,需长期随诊进一步观察。     

生物反馈盆底肌肉训练治疗女性压力性尿失禁

目的:通过生物反馈盆底肌肉训练治疗女性压力性尿失禁6例分析，探讨生物反馈盆底肌肉训练治疗女性压力性尿失禁的效果，以期寻找女性压力性尿失禁较好的非手术治疗方法。方法:我院2003年9月～2004．年1月共有6例女性尿失禁患者接受了生物反馈盆底肌肉训练，平均年龄44岁(31～61岁)，治疗前通过病史问卷、查体诊断尿失禁，其中5例压力性尿失禁，1例压力性尿失禁与急迫性尿失禁合并存在。压力性尿失禁的分度2例中度，4例为轻度。治疗采用Femiscan生物反馈治疗仪，可反馈测量患者盆底肌肉肌电，治疗疗程8～12周，每周2次，4例患者结束治疗疗程，2例正在治疗疗程之中。通过盆底肌肉肌电测量值及病史问卷评价其效果。结果:4例已完成治疗的患者盆底肌电测量值，治疗前平均肌电值为9．7μV(3．33～15．48μV)，治疗后42．9μV(25．0～72．6μV)，平均提高4．42倍，3例患者的症状改善，均为小于40岁患者，症状改善在治疗的第4～6周出现，1例61岁患者效果不明显。正在进行治疗的2例患者治疗4周，目前症状未见改善。治疗未见副作用。结论：生物反馈盆底肌肉训练是一种安全、有效治疗女性压力性尿失禁的方法，尤其是对于年轻、尿失禁程度较轻的患者效果更佳。     

Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence,risk factors and impact on quality of life in Taiwanese women: An observational cohort study

Objective

The study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.

Risk of stress urinary incontinence twelve years after the first pregnancy and delivery

OBJECTIVE: To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS: In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS: Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION: Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.     

Urinary incontinence in pregnancy and in puerperium: 3 months follow-up after delivery

AIM: The aim of this clinic prospective study was to point out the predisposing risk factors for the development of urinary incontinence during pregnancy and postpartum and to understand how to prevent the symptomatology. METHODS: Sixty seven primipara women at 32 weeks of pregnancy and 3 months after the delivery, were studied through an urogynecological work-up and a questionnaire on the main urinary symptoms. RESULTS: At 32 weeks of pregnancy, 27 patients (40.29%) were affected by stress urinary incontinence (SUI) of type I and 22 (32.83%) by urge incontinence. Three months after delivery, it was observed SUI of type I in 8 patients (15.68%), SUI of type II in 9 patients (17.64%), SUI of type II and II degree cystouretrocele in 3 patients (5.8%) and urge incontinence in 14 patients (27.45%). The most frequent risk factors that were tracked down were: a vaginal delivery, with a prolonged labour, and the episiotomy. We didn't find either substantial changes in the weight between patients continent and incontinent or correlations with the patients' age or with the weight of the foetus and the symptomatology reported. CONCLUSION: It is important to understand the beginning of the urinary symptoms in the pregnant women, to prevent the worsening of it. It is required, however, a long term follow-up on our patients to verify if the urinary incontinence persists or disappears by the time is needed.     

Factors determining the persistence of prenatal stress urinary incontinence 12 months postpartum

ObjectiveWhilst many studies have explored the mechanisms of stress urinary incontinence (SUI) following various modes of delivery, few have examined outcomes of postpartum SUI in women who experienced new-onset SUI during their pregnancy. Our primary objective was to investigate the risk factors for persistent postpartum SUI in women with new-onset SUI during pregnancy at 1-year follow-up following vaginal delivery.Materials and methods303 women with new-onset SUI during pregnancy who underwent vaginal delivery in a university hospital between 2014 and 2015 were included. In-person interviews were conducted for all participants on the second postpartum day, followed by phone interviews at 12 months postpartum, with completion of structured questionnaires, including Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7). Demographic, obstetrics and questionnaire scores were analyzed and compared between the group of women who experienced persistent postpartum SUI and the group who did not.ResultsAt 12 months postpartum, 16.5% (n = 50) of women had persistent postpartum SUI, with 83.5% (n = 253) experiencing resolution of SUI symptoms. Maternal age ≥35 years (aOR = 2.62; 95% CI, 1.40–4.87, P = 0.002), gestational age at birth ≥40 weeks (aOR = 2.21; 95% CI, 1.12–4.37, P = 0.022), and severe perineal lacerations (aOR = 2.32; 95% CI, 1.27–4.45, P = 0.013) were independent risk factors for persistent postpartum SUI for women following vaginal delivery at 1-year follow-up.ConclusionThe prevalence of persistent postpartum SUI at 1-year following vaginal delivery is 16.5%, with advanced maternal age, gestational age at birth ≥40 weeks and severe perineal lacerations being independent risk factors.     

Stress urinary incontinence six months after first vaginal delivery

Objective

To determine the prevalence, severity and impact on quality of life of stress urinary incontinence (SUI) six months after the first vaginal delivery, as well as to investigate the risk factors associated with it.

Study design

We designed a prospective study that included 396 women who had their first vaginal delivery in the Hospital Donostia. Diagnosis and identification of the type of urinary incontinence were carried out considering the 2002 ICS definitions. Women were interviewed and examined twice, at term and six months after delivery. The severity of the symptoms was evaluated with the Incontinence Severity Index (ISI) and the impact on quality of life was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. The statistical analysis included comparison of means (Student's t-test or analysis of variance) and proportions (Chi square and Fisher's exact tests). Multiple logistic regression analysis was performed using variables that were close to statistical significance.

Results

15.1% of the women reported SUI six months after their first vaginal delivery. The ISI was slight or moderate in the majority of the cases and the impact on quality of life was low. The presence of SUI in pregnant women at term was the only independent risk factor associated with SUI after delivery (OR: 3.71; 95% IC: 1.95–7.06). The type of vaginal delivery did not influence in SUI six months after the birth, not even in women who were continent during pregnancy.

Conclusions

Slight or moderate SUI was common after the first vaginal delivery and the impact on quality of life was low. Urinary incontinence during pregnancy was the only risk factor independently associated with the presence of SUI six months after the first vaginal delivery.     

Hormonal pituitary functions of women with increasing age (author's transl)

Pituitary functioning was observed endocrinologically in women in mature, climacteric and senile periods, and also patients after ovariectomy of both sides. Serum FSH and LH levels, especially in the former, showed a tendency towards increasing from the climacterium (45-49 years) up to the age of 60-64, and thereafter remained constant in a defined level. Serum PRL, ACTH and GH levels had a tendency to decrease after menopause. Serum TSH levels decreased from the age of 60-64 years. The change of responses for LH-RH tests with advancing age was found to be similar to that of serum gonadotropin levels. On the other hand, in the changes of response of PRL and TSH to TRH test with increasing age, there was a reverse tendency to that of gonadotropin to LH-RH. In ovariectomized women who still had a menstrual cycle, there was a great increase in serum FSH and LH after the operation, as against those who had spent 3 years and 10 months, or 4 years and 4 months after menopause, a slight or little increase respectively. Meanwhile, the LH response to LH-RH was higher in the premenopausal ovariectomized women than that of the post-menopausal unovariectomized women.     

Comparison of the quality of life after nonsurgical radiofrequency energy tissue micro-remodeling in premenopausal and postmenopausal women with moderate-to-severe stress urinary incontinence

OBJECTIVE: This study was undertaken to determine the effect of menopause and hormone replacement therapy (HRT) on incontinence quality of life (I-QOL) score improvement in women with moderate-to-severe stress urinary incontinence (SUI) after nonsurgical, transurethral radiofrequency energy (RF) tissue micro-remodeling. STUDY DESIGN: Retrospective review of prospective, randomized, controlled clinical trial. Women with moderate-to-severe SUI were analyzed by menopausal status and HRT use for 10-point or greater I-QOL score improvement (an increase associated with subjective and objective SUI improvement). RESULTS: RF micro-remodeling resulted in 81% of subjects achieving 10-point or greater I-QOL score improvement versus 49% of sham subjects at 12 months ( P = .04). Outcomes did not differ statistically when premenopausal (85%), postmenopausal using HRT (70%), and postmenopausal not using HRT (71%) groups were compared. CONCLUSION: Menopausal status and HRT demonstrated no impact on the quality of life improvement experienced by women with moderate-to-severe SUI who underwent RF tissue micro-remodeling.     

密云农村地区老年女性压力性尿失禁发病情况调查

目的：了解北京市密云县农村老年女性压力性尿失禁（SUI）患病情况及其对生活质量的影响,为探讨利用农村合作医疗网进行健康教育和行为干预提供依据。方法：依托密云地区农村合作医疗网络,分别选取山区和平原的农村乡镇,由当地的居委会和社区卫生服务中心组织,以调查员问卷调查的方式入户调查,问卷的大部分内容根据亚太地区尿控咨询委员会标准,并根据该地具体情况进行调整。分析农村老年女性SUI患病情况及对生活质量的影响。结果：本调查抽取北京市密云县≥60岁的农村老年女性501例,SUI检出率44.91%（225/501）。46.67%（105/225）初次出现症状是在绝经后;32.89%（74/225）认为对从事家务劳动有影响,27.12%（61/225）认为对参加户外活动有影响,19.12%（43/225）不愿去没有卫生间的场所, 15.56%（35/225）因惧怕漏尿故意减少饮水量,5.34%（12/225）因漏尿需频繁更换内裤。因SUI而感到抑郁、焦虑、沮丧难堪、情绪低落、生活乐趣减少的患者分别占25.78%（58/225）、20.45%（46/225）、13.34%（30/225）、29.78%（67/225）和8.45%（19/225）,仅有2.23%（5/225）认为对生活质量无影响。结论：北京市密云地区农村老年女性SUI患病率较高,对患者日常生活质量及心理健康均有影响,应引起广大医务工作者的重视。     

Treatment of leiomyomas with luteinizing hormone-releasing hormone agonist

Twenty-five premenopausal women, 36-54 years of age, with uterine myomas were treated with 600-1,200 micrograms/day of luteinizing hormone-releasing hormone agonist (LHRHa) for 4 months. Eight patients reached menopause following the treatment with LHRHa (menopause group), while the resumption of menstruation occurred within 12 weeks after cessation of the therapy in 17 patients (menstruation group). Although the mean hemoglobin (Hb) concentration in the menopause group increased during treatment and was maintained within the normal range after cessation of the therapy, the Hb concentration in the menstruation group decreased after the resumption of menstruation. Both estradiol and CA125 in the menopause group were reduced during and after treatment. However, these parameters in the menstruation group increased concomitantly with the resumption of ovarian function. LH and FSH were suppressed during treatment, but these gonadotropins in the menopause group increased significantly to the levels of menopause. About a 50% reduction in uterine volume was observed in the menopause group. Three months after completing therapy, the restoration of uterine volume occurred in the menstruation group. Bone density findings in microdensitometry 12 weeks after cessation of the therapy did not differ significantly from those before the treatment. These results demonstrate that LHRHa therapy significantly reduces the uterine volume in patients with leiomyoma. It may be possible to treat selected patients with leiomyoma, including perimenopausal women and high surgical risk women with LHRHa, thus avoiding the need for surgery.     

Incidence and cause of postpartum urinary stress incontinence.

Urinary leakage was reported in 53.5% of our patients at least once during pregnancy. Multigravidae and women older than 30 were affected more often than primigravidae or women younger than 30. 6.2% of all women, who were continent before pregnancy, developed permanent stress incontinence after vaginal delivery. As a conclusion, it can be said, that vaginal delivery itself predisposes for permanent stress urinary incontinence (SUI). Factors, which increase the trauma to the pelvic floor (tear, no episiotomy, forceps or vacuum extraction), show a higher incidence of postpartum persisting SUI without statistic significance. Labour management with epidural anaesthesia showed a statistically proven lower incidence of postpartum persisting SUI in comparison to the pudendal block.