门诊女性下尿路症状患者尿动力学检查结果分析及逼尿肌无力患者的随访

doi:10.19723/j.issn.1671-167X.2019.05.011

摘要/Abstract

摘要：

目的:了解门诊行尿动力检查女性下尿路症状(lower urinary tract symptoms,LUTS)患者的患病情况并分析其尿动力学诊断结果,进一步对逼尿肌无力(detrusor underactive,DU)患者进行随访,了解未经治疗者的自然病程。方法:回顾性分析2005年1月至2015年12月在北京大学人民医院泌尿外科门诊就诊并行尿动力学检查的656名女性患者基本情况及尿动力学检查结果,分析其储尿期症状、排尿期症状、合并疾病及尿动力学诊断分布情况,按年龄、尿动力学诊断分组比较各组间患者症状及尿动力学检查指标差异,按糖尿病患病情况分组比较DU患者LUTS和尿动力学检查指标差异。电话随访163例女性DU患者,了解其所接受的治疗方案,并使用AUAss评分量表评估未经治疗者的疾病发展情况。结果:尿频是本组门诊女性LUTS患者中位居首位的症状(25.03%),其次为压力性尿失禁(stress urinary incontinence,SUI)(20.04%)、尿急(19.97%)、排尿困难(17.32%)、急迫性尿失禁(12.00%)。SUI是LUTS患者的首要尿动力学诊断(36.04%),其次为DU(24.08%)、膀胱出口梗阻(17.58%)。各类型疾病的患病高峰主要集中于51~60岁,年轻女性患者中有较高比例经尿动力学检查后未见明确病因。DU合并糖尿病患者的膀胱感觉较非糖尿病患者迟钝(P<0.05),对DU患者的随访结果还提示,未经治疗者生活质量显著下降(P<0.05)。结论:门诊女性LUTS患者以储尿期症状为主,SUI在尿动力学诊断中占首位。随年龄增长,患者膀胱感觉和逼尿肌功能逐渐减退,老年患者中DU取代SUI成为首要诊断。对于DU患者,糖尿病会影响其膀胱感觉功能,未经治疗的DU患者生活质量显著下降。

关键词: 下尿路症状, 尿动力学, 膀胱疾病, 女性, 门诊病人

Abstract:

Objective: To find out the prevalence of lower urinary tract symptoms (LUTS) and analyze the characteristics of the urodynamics diagnosis in female outpatients. To study the natural history of detrusor underactive (DU) by the followed up. Methods: A retrospective study of the female LUTS outpatients in Peking University People’s Hospital from Jan. 2005 to Dec. 2015 was performed. The basic information and the urodynamic results of a total of 656 female outpatients were collected. The distribution of storage symptoms, voiding symptoms, complications and urodynamic diagnosis were analyzed. The symptoms and urodynamic results were compared among the groups, which were divided according to age, urodynamic diagnosis and diabetes mellitus. A follow-up of 163 female DU outpatients was performed, including the treatments and the American Urological Association symptoms scores (AUAss). Results: Frequency (25.03%) is the most common symptom in female outpatients, followed by stress urinary incontinence (20.04%), urgency (19.97%), and difficulty of voiding (17.32%). Stress urinary incontinence (SUI) accounted for the first (36.04%) of the whole outpatients, followed by the DU (24.08%), and bladder outlet obstruction (17.58%). The patients aged 51-60 years occupied the peak of almost all the diagnosis. There was a higher proportion of the young female patients than that of the middle and old patients diagnosed with no abnormal after the urodynamic study. The first, strong, urge and maximum bladder capacity were significantly larger in DU patients with diabetes than without diabetes. Follow-up results of the DU patients showed there was no significantly difference of the AUAss scores in both the two groups before and after the follow-up, but the quality of life decreased significantly. Conclusion: Female LUTS outpatients showed a main complaint of storage symptoms. SUI ranked the first in female patients with LUTS. With the increase of age, bladder sensation and detrusor function decrease. In elderly patients, DU became the first ranked disease instead of SUI. Diabetes can affect the sensory function of bladder in patients with DU, and then increase the difficulty of voiding. The patients with DU, absent from treatment, experienced a lower quality of life.

Key words: Lower urinary tract symptoms, Urodynamics, Urinary bladder disease, Female, Outpatients

中图分类号:

R694.5

张维宇,夏秋翔,胡浩,陈京文,孙屹然,许克新,张晓鹏. 门诊女性下尿路症状患者尿动力学检查结果分析及逼尿肌无力患者的随访[J]. 北京大学学报（医学版）, 2019, 51(5): 856-862.

Wei-yu ZHANG,Qiu-xiang XIA,Hao HU,Jing-wen CHEN,Yi-ran SUN,Ke-xin XU,Xiao-peng ZHANG. Analysis of urodynamic study of female outpatients with lower urinary tract symptoms and follow-up of the patients with detrusor underactive[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 856-862.

图/表 8

图1

图2

表1

表2

图3

图4

表3

DU患者中有糖尿病和无糖尿病者下尿路症状及尿动力检查指标比较"

Index	With diabetes (n=25)	Without diabetes (n=138)	P value
Age/years, $x ?$ ±s	66.96±10.43	57.55±14.59	0.002
LUTS, n(%)			0.661
Symptoms at storage phase	17 (68)	104 (75.4)
Symptoms at urinating phase	21 (84)	110 (79.7)
Uroflowmetry
Q_max/(mL/s)	12.40 (3.00)	17.00 (7.80)	0.646
Q_ave/(mL/s)	7.10 (2.30)	8.90 (5.30)	0.750
Voided volume/mL	230.00(188.00)	205.00 (154.00)	0.088
Bladder sensation
Capacity of first desire/mL	144.00 (56.00)	137.00 (59.00)	0.043
Capacity of strong desire/mL	279.55±88.78	223.19±90.41	0.011
Capacity of urge desire/mL	360.31±87.93	285.68±94.74	0.004
Maximum cystometric capacity/mL	332.00 (82.00)	334.00 (122.00)	0.031
Pressure-flow study
Q_max/(mL/s)	14.80 (9.50)	11.60 (7.20)	0.506
Q_ave/(mL/s)	6.70 (6.60)	7.90 (5.60)	0.989
P_detmax/(cmH₂O)	31.63±19.64	30.06±18.13	0.407
P_detQmax/(cmH₂O)	30.00 (16.80)	26.70 (16.30)	0.584
Residual urine volume/mL	170.60±160.92	120.45±124.29	0.331

表3

表4

参考文献 21

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Index	Young-age group (<30 years, n=34)	Middle-age group (30-60 years, n=379)	Older-age group (>60 years, n=243)	P value
Feature of LUTS				0.703
Symptoms at storage phase	25 (52.1)	244 (38.6)	177 (40.1)
Symptoms at urinating phase	13 (27.1)	164 (25.9)	109 (24.8)
Urodynamic diagnosis				<0.001
DU	7 (18.9)	82 (19.8)	80 (28.1)
DO	6 (16.2)	24 (5.8)	35 (12.3)
BOO	10 (27.1)	81 (19.5)	60 (21.1)
SUI	2 (5.4)	166 (40.0)	75 (26.3)
Decreased compliance of bladder wall	4 (10.8)	19 (4.6)	14 (4.8)
No abnormalities	8 (21.6)	43 (10.3)	21 (7.4)

Index	Young-age group (<30 years, n=34)	Middle-age group (30-60 years, n=379)	Older-age group (>60 years, n=243)
Uroflowmetry
Q_max/(mL/s)	17.49 (8.4)	15.40 (10.0)	12.90 (10.0)^##
Q_ave/(mL/s)	9.30 (6.3)	8.10 (6.4)	6.50 (4.60)^##
Voided volume/mL	202.00 (128.00)	216.50 (159.00)	199.00 (189.00)^##
Bladder sensation
Capacity of first desire/mL	123.00 (77.00)	134.00 (70.00)^*	155.00 (78.00)^**
Capacity of strong desire/mL	167.83±69.25	216.37±85.61^**	220.80±84.42^**
Capacity of urge desire/mL	230.00 (155.00)	295.00 (93.00)^*	276 (110.00)^*
Maximum cystometric capacity/mL	280.00 (117.00)	336.00 (90.00)^**	329.00 (110.00)^*#
Pressure-flow study
Q_max/(mL/s)	14.10 (13.50)	13.70 (9.60)	11.10 (8.80)^##
Q_ave/(mL/s)	7.50 (8.1)	7.60 (5.90)	5.90 (5.60)^##
P_detQmax/cmH₂O	45.00 (35.00)	35.15 (22.00)	31.00 (17.00)^*
P_detmax/cmH₂O	36.30 (24.70)	27.10 (15.80)^*	24.90 (15.7)^**
Residual urine volume/mL	0 (10.00)	0 (25.00)	30 (86.00)^##

Score	At examination	At follow-up	P value
AUAss	13.46±6.41	13.37±7.50	0.940
Urinating phase	9.89±5.66	9.61±6.10	0.792
Storage phase	3.57±3.02	3.73±3.04	0.735
QoL	4.73±0.84	4.18±1.32	0.001