Videourodynamic Evaluation of the Pathophysiology of Lower Urinary Tract Symptoms in Neurologically Intact Women

使用錄影尿動力學評估神經正常之女性下尿路症狀之病理生理學

郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 11卷3期 (1999/09) Pp. 203-213

https://doi.org/10.6440/TZUCMJ.199909.0203

摘要

目的：使用錄影尿動力學以評估無神經病變之女性排尿障礙的病理生理學。病人及方法：從1997年9月至1998年10月一共有256位連續性神經學正常的婦女被轉介至本院以進行錄影尿動力學以瞭解其下尿路症狀之原因。我們進行標準化的錄影尿動力學研究並同時進行Valsalva漏尿壓力測定。結果：病人年紀由10歲至92歲（平均56.1±13.9歲）。檢查結果顯示256位病人中，46位(18.0%)具有正常之膀胱及尿道功能，102位(39.8%)具有超敏感性膀胱，44位(17.2%)有逼尿肌不穩定性收縮，77位(30.1%)有低逼尿肌收縮力，76位(29.7%)有放鬆不良之尿道括約肌。49位病人(19.1%)有真性應力性尿失禁，其中47位具有閉鎖不全的膀胱頸及尿道，並具有膀胱頸移動過度的情形。有25位病人(9.8%)具有高壓力排尿，其中21位有明顯膀胱外阻塞，12位有尿道狹窄及逼尿肌不穩定。在129位尿失禁病人當中，30位(23.3%)具逼尿肌不穩定，18位(14.0%)具逼尿肌不穩定以及逼尿肌收縮力不足。在所有256位病人當中共發現有369種膀銧及尿道不正常功能。237位病人(92.6%)具有一種以上的下尿路症狀，157位(61.3%)具有一種以上的膀胱及尿道不正常功能。最大尿流速及排尿量與這些症狀並無明顯關連。結論：本研究結果顯示錄影尿動力學在診斷婦女下尿路症狀極有幫助，只有基於正確的膀胱尿道病理生理學診斷，才能使他們得到良好的內外科治療並且達到良的治療結果。

關鍵字

女性 ； 下尿路症狀 ； 錄影尿動力學

並列摘要

Objective: To determine the pathophysiology of voiding dysfunctions in women without neuropathy by videourodynamic study. Patients and Methods: From September, 1997 to October, 1998, 256 consecutive neurologically intact women were referred for videourodynamic study to define the pathophysiology of lower urinary tract symptoms (LUTS). Standard video-pressure-flow study was performed and the Valsalva leak point pressure was determined. Results: The patients ranged in age from 10 to 92 years (mean 56.1±13.9). Of the 256 women, 46 (18.0%) had a normal bladder and normal urethra, 102 (39.8%) had a hypersensitive bladder, 44 (17.2%) had detrusor instability, 77 (30.1%) had low detrusor contractility, and 76 (29.7%) had a poor relaxation of external sphincter. Genuine stress incontinence was found in 49 (19.1%), 47 of whom had an incompetent bladder neck and urethral incompetence with hypermobility, and 2 of whom did not have hypermobility. High pressure voiding was noted in 25 women, of whom 21 had bladder outlet obstruction and 12 had definite urethral stricture with detrusor instability. Of the 129 women with incontinence, detrusor instability was found in 30 (23.3%) and detrusor instability with inadequate contractility was found in 18 (14.0%). Among the 256 women studied, a total of 369 bladder and urethral abnormalities were found. Two hundreds and thirty-seven women (92.6%) had more than one LUTS and 157 women (61.3%) had more than one bladder and urethral abnormalities. Qmax and voided volume were not associated with the pathophysiology of LUTS. Conclusions: These findings show that videourodynamic study is helpful in the diagnosis of LUTS in women. Only with an accurate diagnosis based on the pathophysiology of the bladder and urethra can proper medical or surgical treatment e given and a good therapeutic outcome achieved.

並列關鍵字

woman ； lower urinqry tract symptoms ； videourodynamics ； pathophysiology