女性膀胱頸失能之錄像尿路動力學分析
翁慧鈴、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
Hueih Ling Ong , Cheng-Lin Lee, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien City,
Purpose: To analyze women with voiding dysfunction by videourodynamic study (VUDS), in particular, examined the role of bladder neck and the effectiveness of treatment.
Materials and Methods: This study retrospectively analyzed the clinical symptoms and VUDS characteristics from 1914 women who referred for evaluation and treatment. The age distributions, presence of detrusor overactivity and treatment modalities in patients diagnosed with BND were analyzed.
Results: Based on VUDS findings, female voiding dysfunction included bladder dysfunction (n=1048, 55%), bladder outlet dysfunction (n=810, 42%) and normal VUDS tracing (n=56, 3%) Table 1. The VUDS findings of bladder outlet dysfunction included BND (n=100, 12.3%), poor pelvic floor relaxation (n=336, 41.5%), dysfunctional voiding (DV, n=325, 40.1%), cystocele (n=19, 2%) and urethral stricture (n=30, 4%). Compared with normal tracing group, BND patients had significantly lower first sensation of filling, full sensation and voided volume, maximum flow rate (Qmax); but higher post-void residual volume, voiding detrusor pressure, and bladder outlet obstruction index (all p <0.05). Detrusor overactivity was noted in 46 (46%) BND patients. These urodynamic parameters, however, were not significantly different from patients with DV. High pressure BND had a greater bladder outlet obstruction degree but low pressure BND had a lower voiding efficiency Table 2. Alpha-blocker improved 62.3% of Qmax whereas transurethral incision of the bladder neck (TUI-BN) improved 63.1% of Qmax in patients who failed medical treatment (p<0.05).
Conclusion: BND comprises 12.3% of women with bladder outlet dysfunction. The VUDS characteristics are in accordance with that in bladder outlet obstruction and the obstruction site is the bladder neck. Alpha-blockers and TUI-BN are effective in improving Qmax in BND patients.