Dysfunctional Voiding in Women with Lower Urinary tract Symptoms

具下尿路症狀婦女之功能性排尿障礙

郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 12卷4期 (2000/12) Pp. 217-224

https://doi.org/10.6440/TZUCMJ.200012.0217

摘要

目的：功能性排尿障礙指排尿時尿道括約肌或骨盆底肌肉無法放鬆的異常狀態。功能性排尿障礙會造成下尿路症狀，反復性尿路感染，以及尿失禁。本研究在探究台灣婦女此種功能性排尿障礙的特徵，臨床表現及尿動力學結果。病人及方法：本研究一共收集34位具有功能性排尿障礙的婦女，這些病人並沒有明顯的神經性病變或急性尿路感染。我們為病人進行錄影尿動力學檢查，並分析其尿動力學結果與排尿膀胱尿道造發現。結果：在臨床症狀方面，有32位主訴頻尿(94%)，22位具有小便遲緩，排尿困難或殘尿感(64.7%)，14位有急尿及急尿失禁(41.2%)。平均排尿壓力(Pdet. Qmax)為47.2±5.21 cmH2O，平均排尿量為217.9±102.7 mL，平均殘尿量為45.6±47.1 mL。尿道外括約肌肌電圖活性在排尿時21位病人為放鬆不良(62%)，113位為活性增加(38%)，排尿膀胱尿道圖顯示膀胱頸開張，後段尿道擴張，但前端尿道則有狹窄現象。有2位病人排尿時發現有第二度膀胱輸尿管逆流。結論：本研究結果顯示在台灣婦女具下尿路症狀的功能性排尿障礙並不少見，使用錄影尿動力學為診斷此一功能性膀胱外阻塞最好的工具。

關鍵字

下尿路症狀 ； 功能性排尿障礙 ； 尿道外括約肌痙攣

並列摘要

Objective: Dysfunctional voiding is an abnormaility of the external urethral sphincter or pelvic floor muscles during voiding. Dysfunctional voiding can cause lower urinary tract symptoms (LUTS), recurrent urinary tract infection, and incontinence in children and women. This study retrospectively investigates the characteristics of dysfunctional voiding in Taiwanese women as well as the clinical symptoms and urodynamic findings. Patients and Methods: In total, 34 women with dysfunctional voiding were identified by a videourodynamic study was performed as a standard procedure, and the urodynamic parameter and voiding cystourethrographic results were analyzed; the clinical characteristics are discussed. Results: Clinically, 32 patients complained of frequency and nocturia (94%); 22 patients had hesitancy, dysuria, or residual urine sensation (64.7%); and 14 patients had occasional urgency and/or urge incontinence (41.2%). The mean Pdet at Qmax was 47.2±17.3 cmH2O, them mean Qmax was 45.6±47.1 mL. Detrusor instability was found in 16 patients (47.1%). External sphincter electromyographic (EMG) activity was noted to be poorly relaxed during the voiding phase in 21 patints (62%), with increased EMG activity in the other 13 patients (38%). Voiding cystourethrography revealed an open bladder neck and dilated proximal urethra with a spinning top distalurethra in all patients. Two patients were found to have bilateral grade 2 vesicoureteral reflux during the voiding phase. Conclusions: The result of this retrospective study reveals that dysfunctional voiding is not uncommon in Taiwanese women with LUTS. Videourodynamic study is the best tool for the diagnosis of this functional bladder outlet obstruction.

並列關鍵字

lower urinary tract symptoms ； dysfunctional voiding ； spastic urethral sphincter