膀胱内注射肝素治疗女性尿频尿急综合征和间质性膀胱炎的尿动力学结果

Urodynamic results of intravesical heparin therapy for women with frequency urgency syndrome and interstitial cystitis.

作者信息

Kuo H C

机构信息

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

出版信息

J Formos Med Assoc. 2001 May;100(5):309-14.

PMID:11432309

Abstract

BACKGROUND AND PURPOSE

Although intravesical heparin instillation is effective in relieving symptoms in patients with frequency urgency syndrome and interstitial cystitis (IC), its efficacy has not been evaluated by urodynamic study. We used urodynamic studies to evaluate the efficacy of heparin instillation in patients with frequency urgency syndrome and IC.

METHODS

Forty women (mean age, 59.6 yr) with severe frequency, urgency, and suprapubic pain at full bladder were enrolled in this study. Patients underwent videourodynamic study with the potassium chloride (KCl) test. All patients had a positive KCl test and were treated with intravesical heparin 25,000 units twice a week for 3 months. Results of urodynamic study and voiding symptom changes assessed by the International Prostate Symptom Score at the end of treatment were compared with baseline data.

RESULTS

Twenty-nine patients had symptom score improvement of more than 50%, and eight had symptom score improvement of less than 50% but improved nocturia. Significant improvement in symptom score (9.0 +/- 4.0 vs 19.5 +/- 4.6, p < 0.001) and nocturia (2.3 +/- 1.1 vs 5.7 +/- 2.0, p < 0.001) were noted after treatment. Urodynamic study at the end of treatment revealed significant improvements in the first sensation of filling (146 +/- 55.4 vs 96 +/- 46.4 mL, p = 0.001) and cystometric capacity (304 +/- 84.8 vs 262 +/- 89.8 mL, p = 0.002). Posttreatment KCl test was negative in 20 patients, improved in 13, and unchanged in seven. Among the 10 patients with cystoscopically proven IC, eight had symptomatic improvement and four had a negative KCl test after treatment.

CONCLUSIONS

IC and frequency urgency syndrome may be caused by increased urothelial permeability. The results of this study show that intravesical heparin can relieve bladder symptoms in a significant proportion of patients, and this may be associated with the restoration of mucosal integrity.

摘要

背景与目的

尽管膀胱内灌注肝素对缓解尿频尿急综合征和间质性膀胱炎（IC）患者的症状有效，但其疗效尚未通过尿动力学研究进行评估。我们采用尿动力学研究来评估肝素灌注对尿频尿急综合征和IC患者的疗效。

方法

本研究纳入了40名（平均年龄59.6岁）膀胱充盈时出现严重尿频、尿急和耻骨上疼痛的女性患者。患者接受了氯化钾（KCl）试验的视频尿动力学检查。所有患者KCl试验均为阳性，并接受每周两次、每次25000单位膀胱内肝素治疗，持续3个月。将治疗结束时尿动力学研究结果及通过国际前列腺症状评分评估的排尿症状变化与基线数据进行比较。

结果

29名患者症状评分改善超过50%，8名患者症状评分改善低于50%，但夜尿症有所改善。治疗后症状评分（9.0±4.0对19.5±4.6，p<0.001）和夜尿症（2.3±1.1对5.7±2.0，p<0.001）有显著改善。治疗结束时的尿动力学研究显示，初始充盈感觉（146±55.4对96±46.4 mL，p = 0.001）和膀胱测压容量（304±84.8对262±89.8 mL，p = 0.002）有显著改善。20名患者治疗后KCl试验为阴性，13名改善，7名无变化。在10名经膀胱镜证实为IC的患者中，8名症状改善，4名治疗后KCl试验为阴性。