女性膀胱頸功能障礙 – 女性排尿障礙之尿路動力學分析

翁慧鈴、李政霖、郭漢崇

佛教花蓮慈濟醫院 泌尿部

Female bladder neck dysfunction-a videourodynamic analysis of female voiding dysfunction

Hueih Ling Ong, Cheng-Ling Lee, Hann-Chorng Kuo

Department of Urology, Buddhist Tzu Chi Hospital, Hualien, Taiwan

Purpose: We analyzed women with voiding dysfunction (VD) by their videourodynamic study (VUDS), in particular, examined the role of bladder neck and the effectiveness of treatment.

Materials and Methods: We retrospectively analyzed the clinical symptoms and VUDS characteristics from 1914 women who referred to us with VD. We also evaluated age distribution, presence of detrusor overactivity (DO) and treatment modalities in patients diagnosed with bladder neck dysfunction (BND).

Results: Based on VUDS findings, female VD can be divided into 2 groups: bladder dysfunction (BD) and bladder outlet dysfunction (BOD). BOD is comprised of BND, cystolocele, dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and urethral stricture (US). 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%). BND patients had lower first sensation of filling (FSF), full sensation (FS) and voided volume (Vol), maximal flow rate (Qmax); but higher post-voiding volume (PVR), Detrusor pressure while voiding (Pdet), and Bladder outlet obstruction index (BOOI) if compare to normal group, p< 0.05. For most of the BND patients, DO was a concurrent feature especially in those older than 55 years of age (51.6%). No correlation between the prevalence of BND and comorbidities (ie. Hypertension, Diabetes Mellitus, Coronary artery disease, chronic kidney disease or chronic obstructive pulmonary disease) was noted, p> 0.05. Usage of alpha-blockers and transurethral incision of bladder neck (TUI-BN) can significantly improved maximal flow rate (Qmax) in patients with BND from 7.6±4.4ml/s to 12.1±5.0ml/s (p=0.000), 7.5±4.7ml/s to 13.1±6.1ml/s (p=0.007). Alpha-blocker was not inferior to TUI-BN in the treatment of BND, p=0.52..

Conclusions: VD in women is rather a complex and poorly-understood disorder. BND is a common diagnosis in female VD especially in those ³ 55 years old. It is highly associated with DO. Alpha-blockers and TUI-BN are equally effective in improving Qmax in BND patients.