以錄影尿路動力學檢視膀胱頸與骨盆底肌肉在女性排尿障礙扮演之角色
李政霖、郭漢崇
花蓮慈濟醫院 泌尿部
Female voiding dysfunction- a videourodynamic analysis of the role of bladder neck and pelvic floor muscles
Cheng-Ling Lee, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
Purpose:
To date, there is lack of consensus about a precise diagnosis and definition of voiding dysfunction (VD) in women. Symptoms of storage and voiding can manifest solely or co-existing, which might suggest an independent pathophysiology or involved with one another. This makes treatment for female VD especially challenging. In this study, we examined the underlying pathogenesis of female VD and in particular, focused on the role of bladder neck and pelvic floor muscles.
Materials and Methods:
We retrospectively reviewed all video-urodynamic study (VUDS) from 1914 women who referred to us for investigation of VD. Based on their VUDS findings, female VD can be categorized into 2 domains: bladder dysfunction (BD) and bladder outlet dysfunction (BOD). BOD is consisted of bladder neck dysfunction (BND), cystolocele, dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and urethral stricture (US). We analyzed the age distribution, presence of detrusor overactivity (DO), influence of co-morbidities and treatment modalities in BND and PRES groups.
Results:
BOD was responsible for 42.3% of all female VD cases and in comparison to BD, those with BOD were younger in age (p= 0.000). The most common VUDS findings of BOD were PRES (41.5%), DV (40.1%) and BND (12.3%). BND was prevalent in patients aged >55 years (72%). For most of the BND patients, DO was a concurrent feature especially in those older than 55 years of age (51.6%). Numbers of co-morbid medical conditions were identified in women with VD, including hypertension, type2 diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease; none of these were significantly associated with BND. Usage of alpha blockers can significantly improve maximal flow rate (Qmax) in patients with BND from 7.6±4.39 ml/s to 12.06±4.99 ml/s (p=0.000). In addition, transurethral incision of bladder neck (TUI-BN) can also facilitate self voiding in the cases of BND refractory or intolerant to alpha blockers.
Conclusions:
Voiding dysfunction (VD) in women is rather a complex and poorly-understood disorder. PRES and DU are two most common diagnoses in female VD. BND is prevalent in patients older than 55 and is highly associated with DO. Alpha blockers and TUI-BN are effective in improving Qmax in BND.