女性特发性逼尿肌收缩功能低下患者临床及尿动力学比较研究

曹明欣; 梁月有; 吴喜链; 梁卫洁

女性特发性逼尿肌收缩功能低下患者临床及尿动力学比较研究

- 中山大学附属第一医院泌尿外科(广州, 510080)
基金项目:
广东省科技计划（编号2010B031600067）

详细信息

通讯作者: 梁月有,E-mail:uroliang@126.com

中图分类号: R699.7

收稿日期: 2012-07-19

A comparative study of clinical and urodynamic features in female idiopathic detrusor underactivity

- Department of Urology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China

More Information

Corresponding author: LIANG Yueyou, E-mail: uroliang@126.com

Received Date: 19 July 2012

摘要

摘要: 目的：探索无明确神经病变、无膀胱出口梗阻的女性特发性逼尿肌收缩功能低下（idiopathic detrusor underactivity，IDU）患者临床症状特点，分析其尿动力学特征，并与正常女性及神经原性逼尿肌收缩功能低下（neurogenic detrusor underactivity，NDU）患者进行比较。方法：回顾性分析于2008年8月~2012年7月因下尿路症状行尿动力学检查的487例女性患者临床资料，共筛选出三组患者：IDU组包含无明确神经损害病史、无膀胱出口梗阻且逼尿肌收缩功能低下患者共49例，NDU组包含因盆腔或腹膜后手术导致的逼尿肌收缩功能低下患者共34例，对照组包含因反复尿路感染行尿动力学检查且认为结果无异常的女性患者共60例。比较三组患者临床症状及尿动力学指标差异。结果：IDU患者下尿路症状表现多样，以排尿期症状为主，但可合并或单独表现为储尿期症状，部分患者合并尿失禁。Q_max较对照组明显降低，而与NDU组无明显差异。压力流率检测时，IDU组PdetQ_max、平均逼尿肌压力、最大逼尿肌压力、膀胱收缩指数等较对照组及NDU组均明显下降，而NDU组与对照组则无明显差异。初始感觉、初急迫及强烈急迫时的膀胱容量IDU组与对照组均无明显差异，但NDU组明显高于对照组。IDU组逼尿肌过度活动（DO）、低顺应性膀胱及压力性尿失禁（SUI）的发生率均低于NDU组。结论：女性特发性逼尿肌收缩功能低下患者下尿路症状表现多样，以排尿期症状为主，主要表现为Q_max下降，剩余尿量增多及逼尿肌收缩力下降甚至无收缩。当无明确神经损害病史时，与NDU的鉴别较为困难，但特发性逼尿肌收缩功能低下患者不易发生DO及SUI，且膀胱感觉功能及顺应性常无明显异常。
- 逼尿肌收缩功能低下 /
- 女性 /
- 尿动力学
Abstract: Objective: To explore the clinical and urodynamic features of female idiopathic detrusor underactivity(IDU) in the absence of overt neuropathy and bladder outlet obstruction, by comparing with normal female controls and neurogenic detrusor underactivity(NDU) patients.Method: We reviewed 487 female patients who had undergone a urodynamic study for LUTS between 08/2008-07/2012. 3 groups were enrolled:IDU group included 49 female patients with detrusor underactivity in the absence of overt neuropathy and bladder outlet obstruction. NDU group included 34 female patients with detrusor underactivity resulting from pelvic or retroperitoneal operation. The control group was formed by 60 age-matched females with unexplained recurrent urinary tract infections who, when seen by us, showed normal clinical and urodynamic findings. The differences of clinical features and urodynamic parameters among three groups were compared respectively.Result: Female patients with IDU presented with a wide range of lower urinary tract symptoms associated with both voiding and storage symptoms, but mainly with voiding symptoms. Some of them also had urinary incontinence. Q_max in IDU group were significantly lower than that in controls, but not different from that in NDU group. In pressure-flow study, PdetQ_max, mean pressure, peak pressure, bladder contractility index in IDU group were significantly lower than those in controls and than those in NDU group, but these parameters were not significantly different between in NDU group and in controls. There was no significant difference between IDU group and controls in the first sensation, first desire and strong desire to void volume. But females with NDU had a higher first sensation, first desire and strong desire to void volume than did those controls. The prevalence of detrusor overactivity, low compliance and stress urinary incontinence(SUI) in IDU group was lower than that in NDU group.Conclusion: Female patients with IDU present with a wide range of lower urinary tract symptoms associated mainly with voiding symptoms. The main symptoms maily include decreased Q_max, increased PVR, and reduced detrusor pressure or even acontractile detrusor. It is difficult to differ IDU from NDU in the absence of overt neuropathy. Females with IDU don`t easily suffer from DO or SUI. Bladder sensation and compliance in IDU females are always normal.
- detrusor underactivity /
- female /
- urodynamics

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参考文献(8)

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