Objective:To explore the features of free uroflow(FF) curve patterns in female patients with detrusor underactivity(DU) and their clinical significance.Methods:Data of 275 adult female patients with lower urinary tract symptoms(LUTS) underwent urodynamic studies(UDS) at urology center of our hospital from June 2014 to June 2016 were analyzed retrospectively. The uroflow curve patterns of patients with DU were classified and analyzed in the context of parameters of FF, cystometry (CM), and pressure-flow study(PFS). The prevalence of each abnormal uroflow curve pattern in DU patients were calculated and compared with those in non-DU patients.Results:No bell-shaped curve was found in 141 patients with DU. The abnormal curve patterns can be divided into 5 types: Type Ⅰ (bell-shaped curve with saw tooth) in 20 cases (14.2%), Type Ⅱ (box-like curve) in 34 cases (24.1%), Type Ⅲ (triangle curve with decreasing slop) in 62 cases(43.9%), Type Ⅳ (triangle curve with increasing slop) in 4 cases (4.3%), Type Ⅴ (tide-wave curve)in 19 cases (13.5%). Maximum flow rate of free uroflow(Q max.FF) of type Ⅰ [(28.4±9.7) ml/s] was significantly greater than that of type Ⅱ, Ⅲ and Ⅴ[(17.0±4.1), (15.8±5.4) and (12.9±6.4) ml/s, P<0.05]. Flow time of free uroflow(FT.FF) of type Ⅲ and Ⅴ [(43.7±17.2) and (50.1±28.9)s] were significantly longer than that of type Ⅰ and Ⅱ [(18.5±7.3)s and (27.2±9.7)s, P<0.05]. Post voided residual > 50ml was noted in 19 cases (30.6%) of type Ⅲ, 7 cases (36.8%) of type Ⅴ, 1 case (2.9%) of type Ⅱ and no one in type Ⅰ and Ⅳ. Abnormal manifestations in cystometry mainly included bladder hypersensitivity, detrusor overactivity, and stress urinary incontinence. Detrusor pressure at Q max (Pdet.Q max) of type Ⅴ [(7.4±5.0) cmH 2O] was significantly lower than that of type Ⅰ, Ⅱ, Ⅲ [(11.8±6.7), (12.0±5.3), (12.1±5.0) cmH 2O, P<0.05]. Among 134 cases of non-DU, there were type Ⅰ curves in 88 cases (65.7%), type Ⅱ curves in 4 cases (2.9%), type Ⅲ curves in 15 cases (11.2%), type Ⅳ curves in 1 cases (0.7%), type Ⅴ curves in 7 cases (5.2%). And normal bell-shaped curves in 19 cases(14.2%). The prevalence of type Ⅱ, Ⅲ and Ⅴ in DU patients was significantly higher than that in the non DU patients ( P<0.05). Conclusions:This study reveals that the characteristics of reduced detrusor contractility and duration, prolonged bladder emptying or incomplete emptying can be reflected in the patterns of free uroflow curve in female patients with DU. The abnormalities of these free uroflow curve patterns, especially type Ⅱ, Ⅲ and Ⅴ will be helpful in preliminarily screening DU in females.

目的:探讨尿道内置7F三腔测压管对压力-流率测定(pressure-flow study,PFS)时尿流率的影响.方法:回顾性分析2011年9月-2016年4月在华中科技大学同济医学院附属同济医院行尿动力学检查的患者资料,筛选出女性压力性尿失禁(stress urinary incontinence,SUI)、逼尿肌活动低下(detrusor underactivity,DU)、膀胱出 口梗阻(bladder outlet obstruction,BOO)、逼尿肌过度活动(detrusor overactivity,DO)患者,共计 875 例.剔除置管前后尿流量相差超过20％的患者,最终406例患者被纳入研究.PFS采用7F三腔测压管,对比自由尿流率(free flow,FF)和PFS时的参数:最大尿流率(maximum flow rate,Qmax),尿流时间(flow time,FT),尿流量(voided volume,VV)以及尿流曲线形态变化.结果:各组的Qmax-PFS＜Qmax-FF且FT-PFS＞FT-FF.在女性患者中,SUI组的Qmax下降比例大于DU组.置管前后尿流曲线发生明显改变者在男性BOO组、DO组、DU组分别占 35.0％、30.4％、14.7％;在女性 DO 组、SUI 组、BOO 组、DU 组分别占 52.9％、50.3％、41.5％、30.0％.结论:尿道内置7F三腔测压管会降低Qmax并延长尿流时间,测压管对尿流率的影响程度可能与性别和膀胱尿道的病理生理状态有关.

为了评价经尿道联合经阴道Smooth模式铒激光(Er∶YAG)照射治疗女性压力性尿失禁(SUI)的安全性和有效性,本研究选取了2018年10月—2019年9月期间于我院门诊就诊的21例患有轻中度SUI的已婚成年女性.所有患者均在局部麻醉下分3次接受经尿道联合经阴道Smooth模式铒激光照射治疗,每次治疗间隔4周并对治疗前、治疗后1个月和3个月的疗效以及相关不良事件分别进行统计和随访.疗效的统计随访采用国际尿控学会(ICS)标准化1 h尿垫试验(ICS-pad test)和国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-SF),统计学分析采用配对样本t检验.结果显示,治疗后1个月和3个月随访的ICIQ-SF评分和1 h尿垫试验显著下降(P＜0.05),术后3个月有效率为81％,治疗后均未出现严重不良反应.提示经尿道联合经阴道Smooth模式铒激光照射治疗方式具有治疗时间短、治疗效果明显的优势,对治疗轻中度女性SUI是安全有效的.

目的 探讨尿动力学(UDS)在慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)疾病诊断中的应用价值.方法 2015年1月～2019年4月就诊的CP/CPPS病人204例,分析其尿动力学检查结果,包括自由尿流率、充盈期膀胱压力容积、排尿期压力流率测定.结果 204例病人中,最大尿流率(14.3 +6.4) ml/s(3.8 ～62.5 ml/s),自由尿流率排尿量(339.6±126.3) ml(91.2～ 801.2ml),＜300ml者80例(39.2％),＞500 ml者23例(11.3％),尿流率曲线形态为正常钟形92例(45.1％),低平曲线96例(47.1％),波浪形16例(7.8％),膀胱残余尿者＞50 ml者13例(6.4％).膀胱敏感性增高61例(29.9％),逼尿肌无抑制性收缩26例(12.7％),膀胱容量减少24例(11.8％),膀胱逼尿肌收缩力降低130例(63.7％),膀胱逼尿肌无力6例(2.9％),膀胱出口梗阻14例(6.9％),UDS未发现异常者44例(21.6％).结论 UDS检查可以明确CWCPPS病人存在的特定下尿路功能障碍类型,进而采取针对性的治疗.