回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁的疗效随访

背景:神经原性尿失禁手术治疗方法多样,疗效不一,探讨手术治疗神经原性尿失禁的效果,以求证其有效性.目的:评价去粘膜回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁疗效,为改良手术提出建议.设计:以患者为研究对象的回顾性病例分析.单位:一所大学医院的小儿外科.对象:对郑州大学第一附属医院小儿外科自1998-04/2004-01手术治疗的68例神经原性尿失禁患者进行随访,所有患者术前均确诊为神经原性尿失禁,随访资料完整者共38例.方法:对38例反射亢进型神经原性膀胱患者随访4～69个月,平均17.2个月.患者年龄4～17岁,38例患者行去粘膜回肠浆肌层补片膀胱扩大术,34例盆底肌松弛者同时行双侧髂腰肌盆底加强术.主要观察指标:观察手术前后症状、膀胱顺应性、最大膀胱容量和相对安全膀胱容量.结果:30例(79%)尿失禁症状改善(控尿时间＞1 h);尿动力学检查示:所有行回肠去浆肌层膀胱扩大术患者术后均为腹压排尿,尿流动力学检查均未发现在排尿期有主动的逼尿肌收缩;术后顺应性增加(27.43&;#177;24.78)mL/kPa(P＜0.01),最大膀胱容量较术前增加(122.18&;#177;79.99)mL(P＜0.01),相对安全膀胱容量较术前增加(98.63&;#177;86.78)mL(P＜0.01).未发现有上尿路功能受损加重情况.结论:去粘膜回肠浆肌层补片膀胱扩大术可保护上尿路功能,是有效治疗神经原性膀胱的一种方法.     

儿童反射亢进型神经原性尿失禁的手术治疗及术后排尿训练

背景脊柱裂引起的脊髓发育不良是儿童最常见的神经系统发育畸形之一,由此而引起的神经原性尿失禁可严重影响患儿的生活质量.目的观察反射亢进型神经源性尿失禁的手术治疗及术后排尿训练效果.设计前后对照,随访观察.单位郑州大学第一附属医院的小儿外科.对象于1992-01/2000-10治疗81例反射亢进型神经原性尿失禁患儿,男54例,女27例,年龄4～14岁,术前检查均证实盆底肌松弛,膀胱容量小.所有患者均为神经原性尿失禁患者并经尿流动力学结果证实为反射亢进型神经原性膀胱.方法对81例患者采用双侧髂腰肌加强盆底肌,回肠去黏膜带血管蒂浆肌层补片的基础上,行膀胱扩大术进行治疗,其中5例行锥状肌膀胱颈悬吊.术后3周,伤口愈合良好后,进行康复协调训练.随访患者术后尿失禁症状改善情况.结果81例术后2周拔除尿管后,40例患儿尿前有尿意,尿流呈线状,两次排尿间隔在60 min以上,膀胱最大容量、残余尿量、膀胱压力接近正常或正常,视为明显改善.23例患儿有尿意,尿流呈线状,两次排尿间隔时间在40 min左右,膀胱最大容量、残余尿量较术前减少,膀胱压力增大,视为改善.18例无效,经过正规排尿训练后较前有改善.对9例进行膀胱尿道测压,膀胱压平均1.2 kPa,尿道压平均1.15 kPa,剩余尿30～50 mL,最大容量300～600 mL.81例患儿有63例得到严格随访,完整随访期6个月,其余部分随访资料不完整.63例被随访者中56例控尿明显改善,5例改善,2例无效,总有效率达到97%.结论双侧髂腰肌加强盆底肌,回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大术是治疗小儿反射亢进型神经原性尿失禁的较好方法,配合术后排尿反射及控制训练对治疗效果影响明显.     

儿童反射亢进型神经原性尿失禁的手术治疗及术后排尿训练

背景：脊柱裂引起的脊髓发育不良是儿童最常见的神经系统发育畸形之一，由此而引起的神经原性尿失禁可严重影响患儿的生活质量。目的：观察反射亢进型神经源性尿失禁的手术治疗及术后排尿训练效果。设计：前后对照，随访观察。单位：郑州大学第一附属医院的小儿外科。对象：于1992-01／2000—10治疗81例反射亢进型神经原性尿失禁患儿，男54例，女27例，年龄4—14岁，术前检查均证实盆底肌松弛，膀胱容量小。所有患均为神经原性尿失禁患并经尿流动力学结果证实为反射亢进型神经原性膀胱。方法：对81例患采用双侧髂腰肌加强盆底肌，回肠去黏膜带血管蒂浆肌层补片的基础上，行膀胱扩大术进行治疗，其中5例行锥状肌膀胱颈悬吊。术后3周，伤口愈合良好后，进行康复协调训练。随访患术后尿失禁症状改善情况。结果：81例术后2周拔除尿管后，40例患儿尿前有尿意，尿流呈线状，两次排尿间隔在60min以上，膀胱最大容量、残余尿量、膀胱压力接近正常或正常，视为明显改善。23例患儿有尿意，尿流呈线状，两次排尿间隔时间在40min左右，膀胱最大容量，残余尿量较术前减少，膀胱压力增大，视为改善。18例无效，经过正规排尿训练后较前有改善。对9例进行膀胱尿道测压，膀胱压平均1．2kPa，尿道压平均1．15kPa，剩余尿30-50mL，最大容量300—600mL。81例患儿有63例得到严格随访，完整随访期6个月，其余部分随访资料不完整。63例被随访中56例控尿明显改善，5例改善，2例无效，总有效率达到97％。结论：双侧髂腰肌加强盆底肌，回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大术是治疗小儿反射亢进型神经原性尿失禁的较好方法，配合术后排尿反射及控制训练对治疗效果影响明显。     

反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经及一氧化氮的变化对膀胱功能的影响

目的：研究反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经分布和一氧化氮(NO)含量的变化，探讨其对膀胱功能的影响。方法：采用免疫组化法测定反射亢进型神经源性尿失禁患儿和膀胱功能正常小儿膀胱顶部逼尿肌中一氧化氮合酶(NOS)阳性神经；利用硝酸还原法测定逼尿肌中NO的含量变化。临床对于81例4～14岁反射亢进型神经源性尿失禁患儿，采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片的基础上，行膀胱扩大术膀胱或包裹术进行治疗。结果：反射亢进型神经源性尿失禁患儿膀胱逼尿肌中NOS阳性神经数及NO含量明显低于正常对照组(P<O．05)。对于81例患者随访6个月～7年，尿失禁症状明显改善63例、术后经严格的训练有改善的18例。但其中有两例效果稍差。结论：反射亢进型神经源性尿失禁患儿膀胱逼尿肌中氮能神经的去神经及NO含量的减少，可能是造成逼尿肌反射亢进的一个因素，采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大或包裹术是治疗小儿反射亢进型神经源尿失禁的一种较好的术式。     

反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经及一氧化氮的变化对膀胱功能的影响

目的:研究反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经分布和一氧化氮(NO)含量的变化,探讨其对膀胱功能的影响。方法:采用免疫组化法测定反射亢进型神经源性尿失禁患儿和膀胱功能正常小儿膀胱顶部逼尿肌中一氧化氮合酶(NOS)阳性神经;利用硝酸还原法测定逼尿肌中NO的含量变化。临床对于81例4～14岁反射亢进型神经源性尿失禁患儿,采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片的基础上,行膀胱扩大术膀胱或包裹术进行治疗。结果:反射亢进型神经源性尿失禁患儿膀胱逼尿肌中NOS阳性神经数及NO含量明显低于正常对照组(P<0.05)。对于81例患者随访6个月～7年,尿失禁症状明显改善63例、术后经严格的训练有改善的18例。但其中有两例效果稍差。结论:反射亢进型神经源性尿失禁患儿膀胱逼尿肌中氮能神经的去神经及NO含量的减少,可能是造成逼尿肌反射亢进的一个因素,采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大或包裹术是治疗小儿反射亢进型神经源尿失禁的一种较好的术式。     

小儿骶前畸胎瘤术后尿失禁的治疗与康复

目的探讨小儿骶前畸胎瘤术后尿失禁的排尿控制方法。方法3～14岁患儿12例,均为骶前畸胎瘤切除术后,表现为排尿异常,逼尿肌无反射,尿道压较膀胱压高。全部患儿均采用双侧髂腰肌加强盆底肌,回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌。行膀胱扩大或包裹术治疗。术后3周开始进行长期康复功能训练。结果随访6个月～6年,尿控制明显改善10例。另外2例经过训练也有所改善。膀胱最大容量300mL,膀胱压平均1.66kPa,尿道压平均3.83kPa。结论双侧髂腰肌加强盆底肌,回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌是治疗小儿骶前畸胎瘤术后尿失禁的一种较好方法,术后进行康复协调功能训练也是治疗的重要措施。     

小儿骶前畸胎瘤术后尿失禁的治疗与康复

目的探讨小儿骶前畸胎瘤术后尿失禁的排尿控制方法。方法3-14岁患儿12例，均为骶前畸胎瘤切除术后，表现为排尿异常，逼尿肌无反射，尿道压较膀胱压高。全部患儿均采用双侧髂腰肌加强盆底肌，回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌。行膀胱扩大或包裹术治疗。术后3周开始进行长期康复功能训练。结果随访6个月一6年，尿控制明显改善lO例。另外2例经过训练也有所改善。膀胱最大容量300mL，膀胱压平均1．66kPa，尿道压平均3．83kPa。结论双侧髂腰肌加强盆底肌，回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌是治疗小儿骶前畸胎瘤术后尿失禁的一种较好方法，术后进行康复协调功能训练也是治疗的重要措施。     

神经源性尿失禁膀胱扩大术后早期并发症

目的：了解神经源性尿失禁回肠膀胱扩大术后早期并发症的发生特点及处理办法。方法：对我科治疗的149例神经源性尿失禁患者住院期间出现的早期术后并发症的特点、治疗方法、治疗结果进行总结分析。结果：主要的早期并发症有腹壁造瘘口尿瘘及术后痿口愈合延迟6例(发生率为4．03％)，泌尿系感染21例(发生率为14．09％)，急性尿潴留19例(发生率为12．75％)，粘连性肠梗阻2例(发生率为1．34％)，经相应的处理后均完全恢复。结论：回肠去黏膜浆肌层补片膀胱扩大术存在一定的手术并发症，经相应治疗后可恢复，此种手术是治疗神经源性尿失禁较为安全有效的治疗方法。     

小儿神经源性尿失禁术后功能锻炼指导

脊髓脊膜膨出修补术后及稳性脊柱裂常引起神经源性尿失禁，给患儿带来严重的生理、心理问题，影响患者的生存质量。我院自1992年4月～2000年6月，在双侧髂腰肌加强盆底肌，回肠去粘膜带血管蒂浆肌层补片加强逼尿肌的基础上，行膀胱扩大成形或膀胱包裹术，治疗小儿神经源性尿失禁177例，术后采取功能训练的方法取得了较满意的效果，现报道如下。1 对象与方法1.1 对象本组177例中，男80例，女97例，年龄4～14岁。脊髓脊膜膨出修补术后163例隐性脊柱裂14例。患儿智力发育正常，能够配合术后功能训练。1.2 功能训练方法术后功能训练分近期和远期…     

小儿神经源性尿失禁的外科治疗与康复训练

目的探讨小儿神经源性尿失禁的治疗方法及康复训练方法。方法对4～14岁206例神经源性尿失禁患儿,在改良的髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌的基础上行膀胱扩大术和膀胱包裹术进行治疗。术后3周开始进行长期康复功能训练。结果术后随访半年至7年,尿控制明显改善183例,术后经过训练又有改善23例。结论此方法是治疗小儿神经源性尿失禁的较好方法,康复功能训练也是治疗的重要措施。     

不同时长任脉灸对骶上脊髓损伤后神经源性膀胱患者排尿功能的影响

目的:观察不同时长任脉灸对骶上脊髓损伤(SSCI)后神经源性膀胱(NB)患者排尿功能的影响。方法:选择2016年12月—2018年12月在山东中医药大学第二附属医院康复医学科治疗的SSCI后NB患者60例,采用随机数字表法分为对照组和观察组,每组30例。对照组在患者鸠尾穴至中极穴的任脉段给予任脉灸,每次灸治1 h,3次/周,共治疗4周;观察组每次灸治时间改为2 h,其余治疗操作同对照组,3次/周,共治疗4周。于治疗前、治疗4周后分别采用24 h排尿日记(单次排尿量、24 h排尿次数、24 h漏尿次数)、最大膀胱安全容量和残余尿量评价患者的排尿功能。结果:治疗4周后,对照组排尿次数、漏尿次数、单次排尿量、最大膀胱安全容量、残余尿量分别为(11.25±0.43)次/d、(5.30±0.37)次/d、(148.55±17.81)mL、(301.90±14.73)mL、(72.50±7.21)mL,观察组排尿次数、漏尿次数、单次排尿量、最大膀胱安全容量、残余尿量分别为(9.80±1.51)次/d、(4.45±0.31)次/d、(159.40±10.97)mL、(314.90±16.33)mL、(67.05±7.18)mL。与治疗前比较,2组治疗4周后每日排尿次数、漏尿次数、残余尿量均明显降低,单次尿量、膀胱安全容量均明显升高(P<0.05)。与对照组比较,观察组每日排尿次数、漏尿次数、残余尿量降低更加明显,单次排尿量、最大膀胱安全容量改善更加明显(P<0.05)。结论:长时程任脉灸可以更有效改善SSCI后NB患者排尿功能,减少尿失禁。     

Trospium chloride for the treatment of overactive bladder with urge incontinence

BACKGROUND: Urinary incontinence is caused by an overactive bladder, leading to symptoms of urgency, frequency, and incontinence. Urge incontinence occurs predominantly in women as they age. OBJECTIVES: This article reviews the current primary literature concerning the efficacy and tolerability of the anticholinergic agent trospium chloride (TCl) in the treatment of overactive bladder with symptoms of urge incontinence, urgency, and frequency. The pharmacokinetics of TCl are also reviewed. METHODS: Pertinent articles in English were identified through a search of MEDLINE (1966-present), EMBASE Drugs & Pharmacology (1980-third quarter 2004), Current Contents/Clinical Medicine (week 42, 2003-week 41, 2004), Cochrane Database of Systematic Reviews, MICROMEDEX Healthcare Series, and International Pharmaceutical Abstracts (1970-present). The search terms were overactive bladder, urinary incontinence, trospium, randomized controlled clinical trial, oxybutynin, tolterodine, scopolamine, imipramine, desipramine, and propantheline. RESULTS: TCl, a quaternary amine, exhibits high solubility in water but low oral bioavailability (9.6%) and poor central nervous system penetration. Approximately 80% of the absorbed fraction is renally eliminated as unchanged drug via active tubular secretion, with approximately 15% hepatically metabolized into a spiroalcohol and hydrolysis/oxidation products. In 3 placebo-controlled studies, patients who received TCl had an increase in maximum bladder filling capacity and bladder compliance, with a reduction in maximum cystometric capacity (P < 0.005); however, only 1 of these studies showed an increase in bladder compliance, with reductions in maximum detrusor pressure (P < 0.001), number of voids/d (P < or = 0.001), and incontinence episodes/d (P < or = 0.001). In another placebo-controlled study, TCl reduced the number of voids/d and incontinence episodes/d (both, P < or = 0.001). In 2 double-blind studies, TCl and oxybutynin were similarly effective in significantly increasing maximum cystometric capacity and bladder compliance, and in significantly reducing maximum detrusor pressure compared with baseline (all, P < 0.001); there were no significant differences between the 2 treatments at end point. In a third double-blind study comparing TCl and tolterodine with placebo, only TCl significantly reduced the frequency of micturitions/d (P = 0.01). Commonly reported adverse effects in patients receiving TCl included dry mouth, constipation, and headache. CONCLUSIONS: In the 7 studies reviewed, TCl was effective and well tolerated in patients with urge incontinence caused by idiopathic detrusor muscle overactivity or neurogenic detrusor overactivity resulting from spinal cord injury. However, this agent was associated with anticholinergic adverse effects similar to those of other anticholinergic agents; careful monitoring of tolerability is required.     

An extended-release formulation of oxybutynin chloride for the treatment of overactive urinary bladder.

Detrusor instability, or urinary incontinence, is common in elderly patients, particularly elderly women. The clinical symptoms of overactive, or unstable, urinary bladder include urge urinary incontinence, urgency, and frequency. Mixed urinary incontinence, which comprises urge urinary incontinence and stress incontinence, is manifested by increased intraabdominal pressure on coughing or sneezing. The detrusor muscle of the bladder is under the control of the parasympathetic, or muscarinic, nervous system. The drug of choice in this condition is oxybutynin chloride, which has the ability to block acetylcholine released from parasympathetic nerves in the urinary bladder, preventing contractions of the muscle and exerting a direct spasmolytic effect on the bladder. A new extended-release oral tablet formulation, OROS oxybutynin, uses osmotic pressure to deliver the drug at a controlled rate over approximately 24 hours. It resembles a conventional tablet but has a two-part core consisting of a drug layer and below it, a "push" layer containing osmotically active components, the whole surrounded by a semipermeable membrane with a laser-drilled opening in the drug side. Water in the gastrointestinal tract enters the tablet and mixes with the drug to form a suspension. The "push" layer expands and pushes the suspended drug out of the orifice and into the gastrointestinal tract for eventual absorption. Pharmacokinetic studies have indicated a slow rise in mean plasma concentration of the isomer R-oxybutynin for 4 to 6 hours after a single dose of OROS oxybutynin, followed by maintenance of steady concentrations for up to 24 hours, minimizing the fluctuations between peak and trough associated with TID dosing of 5-mg immediate-release oxybutynin tablets. Efficacy and safety studies comparing the extended-release with the immediate-release formulation of oxybutynin demonstrated equivalent efficacy in patients with overactive urinary bladder. The adverse-event profile of oxybutynin is similar to that of a typical anticholinergic agent such as atropine--dry mouth, constipation, somnolence, blurred vision, headache, and gastrointestinal pain--although in 2 clinical studies, the incidence of dry mouth was less with the extended-release formulation. Once-daily dosing with OROS oxybutynin appears to be well tolerated and effective, as well as convenient, for the treatment of overactive bladder, particularly for elderly patients using multiple medications.     

Refractory neurogenic detrusor overactivity

Refractory neurogenic detrusor overactivity refers to the clinical condition that is no longer manageable by anticholinergic therapy. This condition represents a formidable task to caregivers because the treatment of urinary incontinence and adequate protection of the upper urinary tract become extremely difficult. Treatment options for refractory neurogenic detrusor overactivity include detrusor injections of botulinum toxin and intravesical instillation of vanilloid compounds, mainly resiniferatoxin, or anticholinergic drugs. If these options fail, bladder augmentation or sacral anterior root stimulation offers excellent outcomes, although at much higher costs and risks to the patients.     

脊髓损伤神经源性膀胱患者尿路感染相关危险因素的回顾性研究

目的:明确脊髓损伤后神经源性膀胱患者尿路感染的相关危险因素。方法:对本院康复科收治的67例脊髓损伤后神经源性膀胱患者进行回顾性研究,采集患者的性别、年龄、脊髓损伤原因及损伤平面、神经源性膀胱病程、排尿方式、膀胱容量与压力等。结果:神经源性膀胱患者尿路感染发生率为64.2%。单因素卡方检验分析结果表明患者年龄、性别、脊髓损伤原因、ASIA分级、损伤平面与是否发生尿路感染无关,而神经源性膀胱病程、排尿方式、膀胱压力及膀胱容量是神经源性膀胱患者发生尿路感染的相关因素(P<0.05)。多因素logistic回归的结果显示脊髓损伤后神经源性膀胱发生尿路感染的独立危险因素包括留置导尿管、膀胱容量<200ml、膀胱压力增高(P<0.05)。结论:神经源性膀胱患者尿路感染发生的独立危险因素为留置导尿管、膀胱容量<200ml以及膀胱压力增高。对上述危险因素临床上应采取针对性的防控措施,降低尿路感染的发生,提高生活质量,促进早期康复。     

膀胱尿压测定评定系统在糖尿病神经源性膀胱护理中的应用

目的：观察膀胱尿压测定评定系统在糖尿病神经源性膀胱（ DNB ）护理中的应用效果。方法选择住院治疗的糖尿病神经源性膀胱患者50例,应用膀胱尿压测定评定系统了解膀胱压力容量变化、膀胱安全容量和最大容量、逼尿肌起始活动状态,括约肌状态、逼尿肌/括约肌协同能力,据此制订护理方案并实施,比较干预前后膀胱残余尿量及排尿功能变化。结果本组患者中尿失禁9例,尿潴留40例;膀胱训练后膀胱残余尿量＞200 ml患者从20例降至5例,中重度排尿功能障碍患者从22例降至7例,训练前后比较差异有统计学意义（U值分别为4．73,5．51;P＜0．01）。低顺应性小容量膀胱1例,转外科手术治疗。结论膀胱尿压测定评定系统用于糖尿病神经源性膀胱护理安全可行,可减少膀胱残余尿量,改善排尿功能。     

功能性磁刺激治疗神经原性膀胱的疗效追踪

背景:功能性磁刺激具有安全、无创、无副作用等优点,目前已逐步用于中枢神经传导、疲劳恢复、骨愈合、神经疾病治疗及脑功能研究等各方面,且能改善排尿功能障碍患者的症状。目的:追踪观察功能性磁刺激治疗神经原性膀胱的疗效。设计:自身前后对照实验。单位:华中科技大学同济医学院附属同济医院康复医学科。对象:选择2003-06/2004-06在华中科技大学同济医学院附属同济医院康复医学科住院及泌尿外科就诊的20例神经原性膀胱患者,其中脊髓损伤造成神经原性膀胱12例,其他原因所致的神经原性膀胱8例。方法:采用Dantec公司(丹麦)生产的MagLite型磁刺激仪,经S3神经根和膀胱区的功能性磁刺激治疗,参数设置:强度为70%～80%最大磁强度;频率为5Hz;脉冲长度为1ms。连续磁刺激20次,休息2s,5min/次,2次/d,5d/周,4～6周为1个疗程。主要观察指标:治疗前、治疗后、停止治疗后1,3个月观察以下指标:①排尿次数、平均单次尿量及单次最大排尿量。②因排尿的症状而影响生活质量评分:评分范围为0～6分,得分越高生活质量越差。③国际下尿路综合征症状评分:共7个问题,总分0～35分,得分越高症状越重。结果:20例患者全部进入结果分析。①因排尿的症状而影响生活质量评分:治疗后较治疗前显著下降(3.17±1.53,4.58±1.00,P<0.01),停止治疗后1,3个月虽有上升,但仍低于治疗前(P<0.01)。②国际下尿路综合征症状评分:治疗后较治疗前显著下降(21.42±5.00,28.08±1.51,P<0.01),停止治疗后1,3个月虽有上升,但仍低于治疗前(P<0.01)。③治疗后排尿次数明显减少,平均单次尿量和单次最大排尿量增加(P<0.05);停止治疗1个月,各项指标下降,但仍优于治疗前(P<0.05);停止治疗3个月虽各项指标继续下降,但除平均单次尿量与治疗前比较差异无显著性意义(P>0.05),其余各项仍优于治疗前(P<0.05),且治疗后各时间点比较差异亦无显著性意义(P>0.05)。结论:功能性磁刺激可以显著地改善部分患者膀胱排尿功能障碍,提高患者的生活质量。     

56例中年女性尿失禁患者的尿流动力学分析

目的 研究中年女性(35～55岁)尿失禁患者的尿流动力学变化,提高相应诊治水平.方法 对56例尿失禁的中年女性患者进行尿流动力学研究,并与正常对照组(17例)比较.结果 56例患者中压力性(SUI)尿失禁患者为33例(58.93％)(SUI组)、急迫性(UUI)尿失禁患者为9例(16.07％)(UUI组)、混合性(SUI/UUI)尿失禁患者为14例(25.00％)(SUI/UUI组).SUI组患者最大尿流率(Qmax)(27.72±5.21)ml/s高于正常对照组(20.45±7.15)ml/s,差异有统计学意义(P＜0.05);UUI组的膀胱初感容量(FS)、正常排尿感觉(ND)、强烈排尿感觉(SD)、急迫排尿感觉(UD)与正常对照组[(135.65±42.73)ml与(132.70±40.65)ml、(166.24±51.42)ml与(160.70±50.44)ml、(315.75±42.34)ml与(320.75±42.34)ml、(320.24±45.03)ml与(335.75±51.98)ml]比较差异均有统计学意义(P均＜0.05);SUI组及SUI/UUI组患者测得Valsalva漏尿点压力(ALPP)[(62.29±25.40)cm H2O与(88.30±28.54)cm H2O]比较差异有统计学意义(t=13.041,P＜0.05);SUI组患者的最大尿流率时逼尿肌压(Pdet-Qmax)、最大尿道压(MUP)及最大尿道闭合压(MUCP)明显低于正常对照组[(24.29±6.24)cm H2O与(34.45±8.20)cm H2O、(68.20±18.27)cm H2O与(87.14±17.26)cm H2O、(74.24±35.75)cm H2O与(90.66±30.10)cm H2O]差异均有统计学意义(P均＜0.05).结论 中年女性尿失禁患者具有较大患者群体,其分类较为复杂,尿流动力学检查对于明确其诊断及选择正确治疗方法,提高疗效具有重要指导意义.     

Managing urinary incontinence with BioDerm external continence device

Urinary incontinence (UI) is a common problem, experienced by both men and women, and has a significant impact on quality of life. For male patients, UI can be caused by a number of conditions, including post-prostatectomy, neurogenic problems (such as Parkinson's disease, multiple sclerosis and spinal cord injury), dementia, and an overactive bladder. One way of managing male UI is through the use of urinary sheaths - containment devices which capture the urine that is voided involuntarily. This article discusses male UI and its management, looking at common problems encountered when using urinary sheaths. It goes on to describe BioDerm, a new type of continence device that could meet the needs of some groups of men, and is an alternative to the previously used external condom catheter-based system of urinary drainage.