- 期刊
婦女骨盆腔底功能不良的臨床評估
Clinical Assessment of Female Pelvic Floor Dysfunction
摘要
應力性尿失禁與骨盆腔底脫垂為婦女骨盆腔底功能不良的兩大表徵，大部份患者這兩種臨床症狀同時出現。做臨床評估時，應力性尿失禁與骨盆腔脫垂需同時進行。仔細的病史詢問（包括小便方式）與骨盆腔身體理學檢查為治療這些患者的基本要件。完整的或選擇性尿動力學檢查在治療前也需進行。影像尿路動力學合溢尿時膀胱內壓的數值可區分為第二型或第三型應力性尿失禁; 放射線影像檢查如動態核磁共振對複雜的骨盆腔脫垂診斷也有助益。治療前後，應力性尿失禁與骨盆腔器官脫垂的程度需有明確、客觀的區分。數種評估方法可供選擇如Raz’s SEAPI系統與國際尿失禁學會與美國泌尿科學會所推薦的系統。應力性尿失禁治療前尿動力學檢查，完整的或選擇性檢查目前仍無一致的意見，但對複雜的應力性尿失禁，完整的尿動力學檢查仍是必要的。
並列摘要
Female stress urinary incontinence and pelvic floor prolapse are two main clinical manifestations of female pelvic floor dysfunction, and are present concomitantly in most of the patients. Clinical assessment of these two disorders should be made at the same time. Detailed history taking including voiding diary and physical examination is essential. Complete or partial urodynamic studies should be performed before treatment. Video-urodynamic with leak point pressure study is helpful for complicated stress urinary incontinence. Type II and Type III stress urinary incontinence can by differentiated with leak point pressure. Image study such as dynamic MRI can be used for complicated pelvic floor prolapse. Severity and grading of stress urinary incontinence and pelvic floor prolapse should be specified and standardized for pretreatment and post-treatment evaluation. Systems such as SEAPI staging system developed by Raz or standards developed by urodynamics society and AUA are recommended. There are still some controversies for the recommendation of full urodynamics versus partial urodynamic studies before treatment. For complicated stress urinary incontinence, complete urodynamics study is necessary before treatment