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相關文獻
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題 名 | 女性應力性尿失禁--診斷與治療=Female Stress Urinary Incontinence--Diagnosis and Treatment |
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作 者 | 柯明中; | 書刊名 | 長期照護雜誌 |
卷 期 | 13:1 2009.04[民98.04] |
頁 次 | 頁29-40 |
分類號 | 416.274 |
關鍵詞 | 應力性尿失禁; 尿失禁; 骨盆底肌肉訓練; Urinary incontinence; Stress urine incontinence; Pelvic floor muscle exercise; |
語 文 | 中文(Chinese) |
中文摘要 | 尿失禁相當常見,女性比男性普遍;台灣婦女尿失禁盛行率介於23%到43%之間;在各種不同類型的尿失禁中,以應力性尿失禁最為常見,佔50%,其次為混合型尿失禁佔32%,而急迫性尿失禁則佔14%。尿失禁不僅影響婦女生理健康,造成自我印象不佳、缺乏自信,同時也影響社交生活。然而,有尿失禁困擾的婦女,卻只有少數人曾經尋求治療。女性尿失禁的診斷流程包括:病史詢問、理學檢查、解尿日誌、尿失禁問卷調查與尿動力學檢查。完整的病史詢問很重要,必須注意會影響尿失禁的一些醫療狀況;理學檢查部分應包括有無前陰道壁鬆弛、尿道鬆弛與過度移動性;解尿日誌對於分辨尿失禁種類與嚴重度是很好的工具;尿失禁問卷調查則是藉由簡短的問卷以區分尿失禁種類及發生頻率、嚴重度;尿動力學檢查可協助確認尿失禁的原因。在治療部份,應力性尿失禁的第一個治療選項是保守治療,包括減輕體重、骨盆底肌肉訓練、生理回饋、陰道錐體訓練、電刺激治療和陰道托盤等;若上述治療方法失敗,可嘗試使用藥物duloxetine,它可增加尿道阻力,進而促進尿道外括約肌關閉減少漏尿。此外,也可使用內視鏡方式,將一些物質注射於尿道周圍,造成局部膨脹,讓尿道更有效關閉。當以上方法治療失敗,而病患不再生育時,可考慮手術治療;應力性尿失禁手術治療的結果各不相同,但其一致的目標為,在不影響膀胱排空尿液功能的前提下,增加尿道阻力以防止尿液不自主渗漏。 |
英文摘要 | Urinary incontinence (UI) is prevalent and more common in women than in men. The prevalence rates of UI in Taiwanese women range from 23% to 43%. The most common cause of UI was stress (50%), followed by mixed (32%) and urge (14%). UI affects not only the physical health of women but also their body image, self-esteem and social life. Despite the high prevalence and negative outcomes of UI,, women seldom seek treatment. The diagnostic process of UI include a detailed history, physical examination, voiding diary, questionnaires for UI and urodynamic study. A thorough history is important to rule out co-morbid medical conditions. Physical examination should include assessment of anterior vaginal relaxation and urethral mobility. Positive urethral hypermobility is suggestive of stress urine incontinence (SUI). Urinary diaries are helpful for assessing the type and severity of UI. Some questionnaires had been validated and are easy to administer for evaluating symptom severity and quality of life in women with SUI. Urodynamic study is used to determine the precise causes of UI in patients. Conservative treatment for SUI should be offered to patients as a first option. Five percent to 10 percent drop in body weight can improve UI symptoms. Other conservative measures include pelvic floor muscle exercise, biofeedback, vaginal cones, electrical stimulation units, and vaginal pessaries. If above measures fail, pharmacological treatment with duloxetine may be helpful. This drug, by stimulating the pudendal nerve, can improve urethral sphincter closure. Bulking agents can be injected to increase the size of the tissue surrounding the urethra, which promotes more effective urethral closure. If conservative therapies and other less-invasive measures fail in women who have completed their childbearing, surgery is often the treatment of choice. Surgical treatment of SUI in women aims at improving urethral resistance and preventing urine leakage while preserving voluntary and complete bladder emptying. |
本系統中英文摘要資訊取自各篇刊載內容。