陀螺樣近端尿道之夾角在女性功能障礙型排尿的角色
余秉軒1、范玉華1,2、林志杰1,2、林子平1,2、林登龍1,2、黃志賢1,2
1臺北榮民總醫院泌尿部；2國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心
The Role of the Angle of Spinning Top Urethra in Females with Dysfunctional Voiding
Ping-Hsuan Yu1, Yu-Hua Fan1,2, Chih-Chieh Lin1,2, Tzu-Ping Lin1,2, Alex T.L. Lin1,2,
William J.S. Huang1,2
1 Department of Urology, Taipei Veterans General Hospital;
2 Department of Urology, College of Medicine and Shu-Tien Urological Research Center,
National Yang Ming Chiao Tung University
Purpose: The term “spinning top urethra”, which is a typical finding of women with dysfunctional voiding, means marked dilatation of the proximal urethra observed at voiding cystourethrography. To the best of our knowledge, there is no literature dealing with the issue about the role of the angle of spinning top urethra on the severity of lower urinary tract symptoms and urodynamic characteristics. The present study aimed to correlate the angle of spinning top urethra with clinical and urodynamic manifestations.
Materials and Methods: Female patients diagnosed with dysfunctional voiding by video urodynamic study from July 2016 to June 2020 were retrospectively recruited. The angle of spinning top urethra was defined as the included angle of lines from each side of the bladder neck to the urethral meatus. Based on the angle of spinning top urethra, the participants were classified into two groups: more than 30 degrees (M group) vs. less or equal to 30 degrees (L group). All the participants completed the questionnaires regarding the severities of lower urinary tract symptoms, including International Prostate Symptom Score (IPSS), Urinary Distress Inventory (UDI-6), and Overactive Bladder Symptom Score (OABSS) while undergoing video urodynamic study.
Results: A total of 127 patients were recruited, including 52 (40.9%) in the M group and 75 (59.1%) in the L group. The subscore of Q4 (small amount of urine leakage) in UDI-6 was significantly higher in M group than in L group (1.2±1.2 vs 0.8±1.2, p=0.049). There was no significant difference in other total and subscores of IPSS, UDI-6 and OABSS between the two groups. Significantly higher detrusor pressure at peak flow was noted in M group compared to L group (33.5±20.5 cmH2O vs 27.9±14.2 cmH2O, p=0.009). The prevalence of IC/BPS was significantly higher in L group than in M group (37.3% vs. 15.4%, p=0.005).
Conclusions: The greater angle of spinning top urethra might indicate more severe urethra obstruction in women with dysfunctional voiding causing higher detrusor pressure at peak flow and increasing severity of urine leakage. Dysfunctional voiding in women with IC/BPS tends to have lesser angle of spinning top urethra.