合并神经原性膀胱活动低下非瘫痪脊髓功能障碍患者生命质量评估和尿动力学研究

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation (CISC) in nonparalytic spinal cord dysfunction (NSCD) patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey (SF-36). Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58(81% ) patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men (mean age 27±5 year) and 28 women (mean age 26±4 year). The normal volunteers without lower urinary tract symptom were set as control group, including 20 men (mean age 28 ± 4 year) and 20 women (mean age 29±4 year). Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment (35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15). The bladder compliance and maximum cystometric capacity were (320 ± 44 ) ml and ( 338 ±50)ml,(55±15)cm H2O and (60±17)cm H2O respectively, also significantly higher than those before the treatment (131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O). However, detrusor leakage point pressures were (6±2)cm H2O and (6±3)cm H2O respectively, significantly lower than those before the treatment (28 ±9 cm H2 O and 25 ± 6 cm H2O). Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed "their health is better than that one year ago". There was no significant difference in the remission rate between men and women (89% vs 76%) in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

目的 探讨电刺激联合全程指导盆底肌训练治疗女性压力性尿失禁(SUI)合并特发性逼尿肌过度活动(IDO)的疗效.方法选取经尿动力学检查证实为SUI合并IDO女性患者70例.平均年龄(40±7)岁.采用神经肌肉电刺激治疗仪电刺激,每次60 min,每周3次.联合盆底肌训练,每次30 min,每天2次,疗程12周.记录治疗前后患者排尿日记,填写国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)和尿动力学测定,并随访3个月疗效.结果 50例(71%)完成全程治疗.其中尿失禁症状完全消失8例(16%),IDO消失10例(20%),漏尿点压测定无漏尿发生6例(12%).治疗后总排尿次数、总漏尿事件次数、ICI-Q-SF评分、最大逼尿肌不随意收缩压和持续时间分别为(28±5)次/72 h、(10±5)次/72 h、(10±3)、(18±8)cm H2O和(8±3)s,显著低于治疗前的(43±8)次/72 h、(20±6)次/72 h、(17±3),(27±9)cm H2O和(13±6)s(P<0.01);最大排尿量、正常尿意膀胱压测定容量、最大膀胱压测定容量、漏尿点压和最大尿道闭合压分别为(225±48)、(210±48)、(247±48)ml、(94±11)和(59±8)cm H2O,显著高于治疗前的(159±37)、(141±39)、(178±36)ml、(81±15)和(55±8)cm H2O,差异有统计学意义(P<0.01).治疗结束时和3个月后有效率为66%和60%,差异无统计学意义(P>0.05).结论 电刺激联合盆底肌训练是一种治疗女性SUI合并IDO的有效方法.     

膀胱肿瘤患者尿 pH 测定

膀胱肿瘤患者尿ｐＨ测定王瑞宋东奎杨太森魏金星河南医科大学第一附属医院外科郑州４５００５２关键词膀胱肿瘤；尿；ｐＨ愈来愈多的临床和实验室研究显示：膀胱肿瘤的生长与尿液中表皮生长因子以及膀胱肿瘤细胞中高表达的表皮生长因子受体密切相关［１，２］，ｐＨ作为影...     

细胞色素氧化酶2A6基因多态性与膀胱癌易感性的关系

目的 探讨细胞色素氧化酶2A6(CYP2A6)基因多态性与膀胱癌易感性的关系.方法 以病例对照研究方法,应用巢式聚合酶链反应(nPCR)分别检测186例膀胱癌患者和192例非肿瘤人群中CYP2A6代谢酶基因型(CYP2A6*4),对各基因型单独或联合吸烟行为进行统计学分析.结果检测378例标本,膀胱癌组186例,检测到CYP2A6野生型168例,杂合型缺失13例和纯合型缺失5例;对照组192例,野生型150例,杂合型缺失32例,纯合型缺失10例.膀胱癌组CYP2A6基因缺失型频率(9.68%)显著低于对照组(21.88%,P＜0.05,OR=0.383).联合吸烟行为后,吸烟人群膀胱癌发病风险显著高于不吸烟人群(P＜0.05,OR=2.322),吸烟人群中膀胱癌组CYP2A6缺失型频率(7.92%,8/101)显著低于对照组(28.00%,21/75,P＜0.05,OR=0.221),2组间差异有统计学意义.吸烟者中,携带CYP2A6缺失型的个体患膀胱癌的风险显著低于野生型个体(OR=0.221,95%CI为0.092～0.534).结论 CYP2A6基因多态性与膀胱癌易感性有关,该基因多态性与吸烟在膀胱癌的发生存在交互作用,CYP2A6基因缺失可减少吸烟者膀胱癌的发病风险.     

汽化电切术治疗良性前列腺增生症37例

经尿道前列腺汽化电切术(TUVP)是近年来在经尿道前列腺电切除术(TURP)基础上开展的治疗良性前列腺增生症(BPH)的新方法。作者对TUVP术前、术后的国际前列腺症状评分(I-PSS)和尿动力学检查各项参数指标进行观察，以评价TUVP术后疗效，报道如下。     

腺性膀胱炎诊断2 228例文献分析

腺性膀胱炎是膀胱移行上皮的一种增生和化生性病变.近年来由于膀胱镜检查的普及和病理医生对腺性膀胱炎认识的增加,临床报告病例逐年增加.本组收集国内报告的腺性膀胱炎2 228例,对发病年龄、性别、临床表现症状、并发疾病、膀胱镜资料进行统计分析如下.     

副脾误诊为左肾上腺肿瘤3例并文献复习

副脾与肾上腺位置贴近时 ,易被误诊为肾上腺肿物 ,尤其患者有高血压症状时 ,更易被诊断为腺瘤[1 ] 。我们在临床实践中遇到副脾误诊为左肾上腺肿瘤 3例 ,均为手术证实 ,结合文献资料总结如下。1　病例报告例 1　男 ,34岁 ,以发作性头晕、血压高 3个月为主诉入院。3个月前饮酒后出现头晕 ,测 BP180 /12 0 mm Hg,口服复方降压片 1d后下降至 6 0 /40 mm Hg,停药后血压又升至 188/12 8mm Hg。入院查体 :右上肢 BP180 /75 mm Hg,心界向左扩大 ,达左锁骨中线 ,HR72次 /min,律齐。实验室检查 :2 4 h尿VMA88μmol/2 4 h,苄胺唑啉实验阳性。 B…     

遗传性大疱性表皮松解症累及泌尿系统1例报道及文献复习

目的探讨遗传性大疱性表皮松解症(EB)患者泌尿生殖系统并发症的诊疗方案。方法通过诊治1例EB并发泌尿生殖系统病变患者,总结体会并复习相关文献。结果患者男性,14岁,属于3种分型中的隐性营养不良型。泌尿系统病损重点在前尿道黏膜破损,梗阻累及膀胱及上尿路。通过临时留置导尿管,尿道梗阻缓解,3个月后随访彩超示肾积水改善,20个月后随访积水未加重。结论 EB累及泌尿系统临床罕见。透射电镜检查是原发病最重要的诊断方法。针对原发病目前尚无有效治疗方法。泌尿生殖系统并发症的检查和治疗应尽量减少尿路粘膜破坏,通畅引流,保护肾功能。     

经尿道冷刀加钬激光治疗尿道狭窄与闭锁62例疗效观察

尿道狭窄是泌尿外科常见疾病.我们2004-03～2005-07采用经尿道冷刀加钬激光手术治疗尿道狭窄与闭锁62例,疗效满意,现报告如下.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.