Heesakkers John P F A, Vriesema Jessica L J
Department of Urology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
Curr Opin Urol. 2005 Jul;15(4):215-21. doi: 10.1097/01.mou.0000172392.75728.da.
Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the pathology of a patient's complaints. Much progress in standardizing definitions and procedures has been made in recent years. In particular, stress urinary incontinence and overactive bladder can be differentiated with urodynamics. The developed parameters, however, cannot distinguish the various types of stress urinary incontinence. Moreover the definition and diagnosis of voiding dysfunction is not clear. Finally our understanding of bladder sensations and the impact on voiding behaviour has only started to emerge. This review is about last year's publications that focus on urodynamics and lower urinary tract symptoms in women.
Defining bladder outlet obstruction is based on voiding pressure, urinary flow speed and residual urine but standardization is lacking. Urodynamics to reveal occult stress urinary incontinence in patients with pelvic organ prolapse needs standardization of the reducing manoeuvres. The quest for urodynamic tools for distinguishing intrinsic sphincter deficiency from urethral hypermobility continues. Urodynamics are still not good enough to discriminate between treatment options for stress urinary incontinence. The use of urodynamics in overactive bladder is developing and has elicited new findings. Voiding habit seems to be independent from bladder sensations. Also bladder sensations appear to be imperfectly correlated with bladder filling. Even bladder volumes do not predict entirely bladder fullness sensations.
In order to use urodynamics as a proper clinical tool, defining subtypes of stress urinary incontinence and standardization of urodynamics in pelvic organ prolapse and bladder outlet obstruction in women is needed.
尿动力学检查是作为患者病史和体格检查的延伸而发展起来的，旨在揭示患者主诉的病理情况。近年来，在标准化定义和程序方面取得了很大进展。特别是，压力性尿失禁和膀胱过度活动症可以通过尿动力学进行区分。然而，所制定的参数无法区分各种类型的压力性尿失禁。此外，排尿功能障碍的定义和诊断尚不清楚。最后，我们对膀胱感觉及其对排尿行为的影响的理解才刚刚开始出现。本综述关注的是去年发表的聚焦于女性尿动力学和下尿路症状的文献。
基于排尿压力、尿流速度和残余尿量来定义膀胱出口梗阻，但缺乏标准化。在盆腔器官脱垂患者中揭示隐匿性压力性尿失禁的尿动力学检查需要对复位操作进行标准化。区分真性括约肌功能不全和尿道活动过度的尿动力学工具的探索仍在继续。尿动力学在区分压力性尿失禁的治疗方案方面仍不够完善。尿动力学在膀胱过度活动症中的应用正在发展，并已产生了新的发现。排尿习惯似乎与膀胱感觉无关。而且膀胱感觉与膀胱充盈之间的相关性似乎并不完美。甚至膀胱容量也不能完全预测膀胱充盈感。
为了将尿动力学作为一种合适的临床工具，需要定义压力性尿失禁的亚型，并对女性盆腔器官脱垂和膀胱出口梗阻的尿动力学进行标准化。
