239例下尿路排尿功能障碍患者影像尿动力学特点分析

发布时间：2018-06-11 13:09

本文选题：影像尿动力检查 + 排尿功能障碍　；参考：《第三军医大学学报》2015年06期

【摘要】：目的回顾分析我科下尿路排尿功能障碍患者影像尿动力学诊断特点,探讨影像尿动力学在复杂排尿功能障碍患者诊断中的优势。方法收集自2014年1-7月因下尿路排尿功能障碍而在我科行影像尿动力检查患者239例,男性165例,女性74例。分析神经源性膀胱和非神经源性膀胱患者尿动力学诊断特点及下尿路影像形态,探讨典型复杂排尿功能障碍患者尿动力学检查的特点及输尿管、膀胱、尿道形态学的变化。结果 239例患者中因存在明确神经系统病变而出现排尿功能障碍经尿动力学检查确定为神经源性膀胱患者32例(13.39%):1逼尿肌反射亢进伴急迫性尿失禁8例,3例患者存在脑血管意外,1例患者存在帕金森病,2例患者存在阿尔茨海默病,1例患者存在骶脊膜膨出;1例患者行根治性子宫全切。2逼尿肌收缩无力伴尿性尿潴留24例,其中糖尿病患者16例,急性感染性多发性神经根炎患者2例,酗酒患者2例,药物滥用患者1例,高空坠落致腰或骶髓损伤3例。存在单侧输尿管反流1例,双侧输尿管反流7例,逼尿肌膀胱颈协同失调2例,逼尿肌尿道外括约肌协同失调3例。诊断为非神经源性膀胱患者203例(84.94%):膀胱出口梗阻131例、压力性尿失禁41例、单纯逼尿肌过度活动11例、逼尿肌收缩力弱10例、逼尿肌收缩无力10例。排尿期膀胱颈部完全开放76例,部分开放129例,膀胱颈部未见开放34例。膀胱及尿道功能未见异常4例(1.67%)。结论影像尿动力检查可帮助神经源性膀胱患者准确判断是否存在逼尿肌-尿道外括约肌协同失调、逼尿肌-膀胱颈协同失调、输尿管反流、漏尿点压,对于非神经源性膀胱患者,可帮助判断胱和尿道的影像形态变化,精确了解尿道梗阻部位,甚至了解膀胱尿道是否存在异物。
[Abstract]:Objective to analyze the diagnostic characteristics of imaging urodynamics in patients with lower urinary tract dysuria in our department, and to explore the advantages of imaging urodynamics in the diagnosis of complex urination disorders. Methods from January to July 2014, 239 patients (165 males and 74 females) with lower urinary dysfunction underwent radiographic urodynamic examination in our department. The characteristics of urodynamic diagnosis of neurogenic bladder and non-neurogenic bladder and the morphology of lower urinary tract were analyzed. The characteristics of urodynamic examination and the morphological changes of ureter, bladder and urethra in patients with typical complex urinary dysfunction were discussed. Results among 239 patients, 32 patients with neurogenic bladder were diagnosed as neurogenic bladder by urodynamic examination because of clear neuropathy. There were 8 patients with hyperreactivity of detrusor reflex and 3 patients with urgent urinary incontinence. In 1 case of cerebral vascular accident, 2 cases of Parkinson's disease and 2 cases of Alzheimer's disease, 1 case of sacral meningocele, 1 case of radical hysterectomy, 2 cases of detrusor myasthenia and 24 cases of urinary retention. There were 16 cases of diabetes mellitus, 2 cases of acute infectious polyneuritis, 2 cases of alcoholism, 1 case of drug abuse, and 3 cases of lumbar or sacral spinal cord injury caused by falling from high altitude. There were 1 case of unilateral ureteral reflux, 7 cases of bilateral ureteral reflux, 2 cases of detrusor bladder neck coordination disorder and 3 cases of detrusor external sphincter coordination disorder. 203 cases of non-neurogenic bladder were diagnosed as bladder outlet obstruction 131 cases, pressure urinary incontinence 41 cases, simple detrusor hyperactivity 11 cases, detrusor contraction weak 10 cases, detrusor weakness 10 cases. The bladder neck was completely open in 76 cases, partially open in 129 cases, and not open in 34 cases. Bladder and urethral function were not abnormal in 4 cases. Conclusion Imaging urodynamic examination can help patients with neurogenic bladder to judge accurately whether there is detrusor-urethral sphincter synergism, detrusor-bladder neck synergism, ureteral reflux and leakage point pressure. For non-neurogenic bladder patients, it can help to judge the changes of cystathiasis and urethra, to know exactly the location of urethral obstruction, and even to know whether there is foreign body in bladder urethra.
【作者单位】：西安交通大学医学院第一附属医院泌尿外科;
【分类号】：R691.5

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