膀胱頸功能障礙- 以錄影尿路動力學分析女性排尿功能障礙
李政霖、郭漢崇
花蓮慈濟醫院 泌尿部
Female bladder neck dysfunction- a videourodynamic analysis of female voiding dysfunction
Cheng-Ling Lee, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
Purpose: Diagnosis and treatment of voiding dysfunction (VD) in women can be challenging..In this study, we examined the heterogeneous nature of female VD and in particular, bladder neck dysfunction (BND) and its treatment.
Materials and Methods: We retrospectively reviewed videourodynamic reports (VUDS) from 1914 women who referred to us for investigation of VD. Based on their VUDS findings, female VD can be divided into 2 categories: 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 focused on age distribution, presence of detrusor overactivity (DO), influence of co-morbidities and treatment modalities in BND.
Results: In female VD, BOD was accounts for 42.3% (810/ 1914) of all cases. BND is among the common causes of BOD (12.3%; 100/ 1914) (Fig.1). BND was prevalent in patients aged >55 years (72%). For majority of cases (51.6%), DO was a concurrent VUDS feature in those older than 55 years of age (Fig.2). Although several co-morbidities 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 found to have significantly correlation with BND. Use of alpha blockers can significantly improve maximal flow rate (Qmax) in BND from 7.6±4.39 ml/s to 12.06±4.99 ml/s (p=0.000). 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. 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.