CAJ | 학술논문

目的探讨以膀胱疼痛症状为特征的女性膀胱出口梗阻(BOO)患者的诊断及治疗.方法 2008年11月至2012年12月收治的21例以尿频、尿急、憋尿后耻骨上膀胱区疼痛为主诉的女性患者,经自由尿流率+残余尿检查联合影像尿动力学(VUD)检查明确存在BOO.治疗前平均Qmax(11.5±3.6) ml/s,平均PdetQmax(39.1±17.8)cmH2O(1 cmiH20=0.098 kPa).结合排尿期同步影像检查结果诊断为膀胱颈梗阻19例,尿道狭窄2例.本组21例均于硬膜外麻醉下行膀胱水扩张治疗,膀胱镜下观察均为红斑征阳性,均行膀胱黏膜活检,对膀胱颈梗阻患者行膀胱颈内切开术,尿道狭窄患者行尿道扩张术.于术后48个月采用O' Leary-Sant评分、QOL评分及盆腔疼痛和尿频、尿急症状(PUF)评分评价治疗前后患者膀胱疼痛症状的变化. 结果本组21例膀胱黏膜活检病理结果均为膀胱黏膜急、慢性炎症.21例术后随访平均(6.7±5.9)个月,24h排尿次数由治疗前(24.3±11.8)次降至(13.0±5.9)次,平均夜尿次数由(6.5±2.7)次降至(3.3±1.6)次,O ' Leary-Sant评分由(24.6±7.3)分降至(14.7±7.4)分,PUF评分由(22.9±6.2)分降至(12.0±7.1)分,QOL评分由(5.0±0.8)分降至(2.9±1.5)分,差异均有统计学意义(P＜0.05). 结论尿流率+残余尿检查联合VUD检查对以膀胱疼痛症状为特征的女性BOO患者可以明确诊断.根据VUD检查结果解除梗阻后,与膀胱疼痛相关的症状会显著改善.
목적 탐토이방광동통증상위특정적녀성방광출구경조(BOO)환자적진단급치료.방법 2008년11월지2012년12월수치적21례이뇨빈、뇨급、별뇨후치골상방광구동통위주소적녀성환자,경자유뇨류솔+잔여뇨검사연합영상뇨동역학(VUD)검사명학존재BOO.치료전평균Qmax(11.5±3.6) ml/s,평균PdetQmax(39.1±17.8)cmH2O(1 cmiH20=0.098 kPa).결합배뇨기동보영상검사결과진단위방광경경조19례,뇨도협착2례.본조21례균우경막외마취하행방광수확장치료,방광경하관찰균위홍반정양성,균행방광점막활검,대방광경경조환자행방광경내절개술,뇨도협착환자행뇨도확장술.우술후48개월채용O' Leary-Sant평분、QOL평분급분강동통화뇨빈、뇨급증상(PUF)평분평개치료전후환자방광동통증상적변화. 결과 본조21례방광점막활검병리결과균위방광점막급、만성염증.21례술후수방평균(6.7±5.9)개월,24h배뇨차수유치료전(24.3±11.8)차강지(13.0±5.9)차,평균야뇨차수유(6.5±2.7)차강지(3.3±1.6)차,O ' Leary-Sant평분유(24.6±7.3)분강지(14.7±7.4)분,PUF평분유(22.9±6.2)분강지(12.0±7.1)분,QOL평분유(5.0±0.8)분강지(2.9±1.5)분,차이균유통계학의의(P＜0.05). 결론 뇨류솔+잔여뇨검사연합VUD검사대이방광동통증상위특정적녀성BOO환자가이명학진단.근거VUD검사결과해제경조후,여방광동통상관적증상회현저개선.
Objective To explore the diagnosis and treatment of female bladder outlet obstruction (BOO) with bladder pain as major symptom.Methods From November 2008 to December 2012,21 female patients suffered from urinary frequency,urgency,pain in suprapubic area during bladder filling phase were enrolled in the study.Video-urodynamics (VUD) study combined with free urinary flow rate andresidual urine were performed in all patients in order to make the diagnosis of BOO clearly.The mean maximum urinary flow rate was (11.5±3.6) ml/s,and the mean maximal detrusor pressure was (39.1±17.8) cmH2O.Combining with the voiding radiography,19 patients were diagnosed as bladder neck obstruction,and the other 2 were diagnosed as urethral stricture.All patients were accepted the hydrodistension under the epidural anesthesia.The bladder biopsy was performed if the typical glomerulations were observed under the cystoscopy.Bladder neck incision and urethral dilatation were performed on these patients respectively.Symptom changes of bladder pain were recorded by using O'Leary-Sant scale,the pain,urgency,frequency symptom (PUF) scale and quality of Life (QOL) Scale.The data were collected within 48 months postoperation,respectively.Results The pathological findings of bladder mucosa biopsy showed acute or chronic inflammation in all patients.The mean follow-up was 6.7±5.9 months.We compared the corresponding data such as:voiding times per day,nocturnal frequency,O'Leary Sant scores,PUF and QOL between pre and post-treatment.Significant differences were observed during all corresponding data (P＜0.05).The voiding times per day changed from 24.3± 11.8 to 13.0±5.9.The nocturnal frequency decreased from 6.5±2.7 to 3.3± 1.6.O'Leary Sant scores changed from 24.6±7.3 to 14.7±7.4.The PUF scores changed from 22.9±6.2 to 12.0± 7.1.And the QOL scores changed from 5.0±0.8 to 2.9±1.5.Conclusions Free urinary flow rate and residual urine combined with VUD are very important in diagnosing female BOO with bladder pain as major symptom.Bladder pain symptoms will be significantly improved after the obstruction was relieved according to VUD results.