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題名 | 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 |
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作者 | 郭漢崇; Kuo, Hann-chorng; |
期刊 | 慈濟醫學 |
出版日期 | 19990900 |
卷期 | 11:3 1999.09[民88.09] |
頁次 | 頁203-213 |
分類號 | 415.802 |
語文 | eng |
關鍵詞 | 女性; 下尿路症狀; 錄影尿動力學; Women; Lower urinary tract symptoms; Videourodynamics; Pathophysiology; |
中文摘要 | 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 種膀胱及尿道不正常功能。 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。 |
英文摘要 | 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 poor relaxation of external sphincter. Genuine stress incontinence was found 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 stricuture 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 be given and a good therapeutic outcome achieved. |
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