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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 郭嘉政 | 女性排尿障礙 : 2011 國際尿失禁咨詢-研究協會 | 2013/1/29 下午 01:38:45 | 0 |
| 原 文 | 題 目 | Defining Female Voiding Dysfunction: ICI-RS 2011 (International Consultation on Incontinence ~ Research Society.) |
| 作 者 | Dudley Robinson,1* David Staskin, 2 Rosa M. Laterza, 3and Heinz Koelbl3 1Department of Urogynaecology, Kings College Hospital, London, UK 2Department of Urology, Tufts University School of Medicine, Boston, Massachusetts 3Department of Obstetrics and Gynaecology, Johannes-Gutenberg University, Mainz, Germany | |
| 出 處 | Neurourology and Urodynamics 31:313–316 (2012) | |
| 出版日期 | Mar 2012 | |
| 評 論 |
本文乃英國學者Robinson另與美 德 三位學者Review 近期文獻對女性排尿障礙更進一步探討. 女性排尿障礙診治有如女人心海底針不容易捉摸. 不過ICS 及 IUGA 已將女性排尿障礙定義為症狀上 異常慢速排尿及或尿動力學上 不完全排尿. 以歐美多國人口統計調查研究顯示 排尿障礙症狀男性多於女性(25.7% > 19.5%) 然而女性排尿障礙症狀卻偶有合併儲尿障礙症狀 (7-14 %). 但是相對排尿障礙症狀有共識 , 尿動力學上排尿障礙 PVR定義較無共識 , 固此綜合各家研究,作者以為尿動力學上排尿障礙 PVR 訂在100 mls 于女性LUTS 或OAB 患者發生率約 5-10% 為佳. 排尿障礙原因分兩大類 膀胱逼尿肌收縮力低下及或膀胱出口阻塞,又各分生理性或醫源性. 有文獻表示膀胱出口阻塞後逼尿肌收縮力會次發性增加 此論點支持流行病學上排尿障礙症狀可合併儲尿障礙症狀. 尿動力學上最大尿流速 < 12 ml/sec 逼尿肌收縮壓 >20cmH2O 排尿障礙症狀合併儲尿障礙症狀63%. 另外研究顯示 最大尿流速 < 15 ml/sec 逼尿肌收縮壓 > 35 cm H2O 94% Frequency-urgency 44% UUI 再再都顯示女性排尿障礙症狀合併儲尿障礙症狀所在多有,吊詭如謎. Tamsulosin 治療女性排尿障礙症狀有七成幫助。總之女性排尿障礙複雜如附圖 patient X SUI + OAB-wet +VD 有時如身心症般雙極化表現 , 其診治乃需抽絲剝繭 而非一蹴可幾。最後作者建議臨床上治療OAB 用抗毒蕈鹼受體類藥物前後注意有無同時 VD 且最好能監測 PVR ; 反之臨床上治療 BOO 之LUTS 亦需注意其儲尿障礙症狀。作者建議進一步探討 甲型阻斷劑于女性排尿障礙之角色，用抗毒蕈鹼受體類藥物治療OAB前後PVR 變化 。 總結來說本會多位先進于婦女泌尿學的研討應已不遜於歐美學者。  |
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| abstract |
Whilst symptoms of Bladder Outlet Obstruction (BOO) and post micturition symptoms are more commonly reported in men a significant number of women may also complain of voiding dysfunction. However, despite the recent advances in the standardisation of terminology of lower urinary tract dysfunction there remains a lack of consensus regarding a precise diagnosis and definition of voiding abnormalities in women. In addition voiding symptoms may co-exist with storage symptoms as well as those associated with urinary incontinence. Consequently many patients present with a spectrum of different urinary symptoms, related to both storage and voiding, which may be multifactorial in origin or be related to one another. The purpose of this paper is to review the current literature in order to accurately define and classify female voiding dysfunction including causes and aetiology. In addition to reviewing the investigation and management of those women with voiding dysfunction recommendations are proposed for management in clinical practice as well as suggestions for future research |
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