Porena Massimo, Mearini Ettore, Mearini Luigi, Vianello Alberto, Giannantoni Antonella
Department of Urology and Andrology, University of Perugia, Policlinico Monteluce, Perugia, Italy.
Eur Urol. 2007 Jul;52(1):38-45. doi: 10.1016/j.eururo.2007.03.051. Epub 2007 Mar 26.
To analyse the relationship between RRP and urodynamic bladder dysfunction, and compare preoperative and postoperative functional status over long-term follow-up. Hypothesis on the pathophysiologic mechanism underlying urodynamic dysfunction has been reported.
PubMed databank search for original articles followed by review of urodynamic parameters: bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, urinary incontinence.
Detrusor dysfunction was rarely present as the sole diagnosis and was usually coupled with intrinsic sphincter deficiency. Data on bladder filling sensation, cystometric capacity, detrusor overactivity, impaired detrusor contractility, and bladder outlet obstruction were limited and contradictory. Detrusor overactivity was a de novo dysfunction in 2%-77% of patients. Impaired bladder compliance was present in 8%-39% of patients and was de novo in about 50%. Impaired detrusor contractility was found in 29%-61% of patients, was de novo in 47%, and recovered in about 50% of patients. The role of these dysfunctions as etiologic agents of urinary incontinence or voiding symptoms was unevenly assessed.
Postoperative decentralization of the bladder, inflammation and/or infection, and geometric bladder wall alteration associated with preexisting hypoxemia with/without neuroplasticity have been posited as causes of detrusor dysfunction. Nevertheless, the lack of consistent preoperative urodynamic investigation makes it difficult to assess the operation's exact role in causing these dysfunctions. Thus, urodynamics performed, at least in selected cases, preoperatively and during follow-up could help arrive at a precise diagnosis of the underlying dysfunction, indicate the appropriate treatment, and prevent the incidence and onset of postoperative urinary incontinence.
分析复发性呼吸道乳头状瘤病（RRP）与尿动力学膀胱功能障碍之间的关系，并在长期随访中比较术前和术后的功能状态。关于尿动力学功能障碍潜在病理生理机制的假说已有报道。
在PubMed数据库中检索原始文章，随后回顾尿动力学参数：膀胱充盈感觉、逼尿肌过度活动、膀胱顺应性、膀胱测压容量、逼尿肌收缩力受损、膀胱出口梗阻、尿失禁。
逼尿肌功能障碍很少作为唯一诊断出现，通常与固有括约肌缺陷相关。关于膀胱充盈感觉、膀胱测压容量、逼尿肌过度活动、逼尿肌收缩力受损和膀胱出口梗阻的数据有限且相互矛盾。2%-77%的患者中逼尿肌过度活动是一种新发功能障碍。8%-39%的患者存在膀胱顺应性受损，其中约50%是新发的。29%-61%的患者发现有逼尿肌收缩力受损，47%是新发的，约50%的患者恢复。这些功能障碍作为尿失禁或排尿症状病因的作用评估并不一致。
术后膀胱去神经支配、炎症和/或感染，以及与既往存在的低氧血症相关的膀胱壁几何形状改变（伴或不伴神经可塑性）被认为是逼尿肌功能障碍的原因。然而，术前缺乏一致的尿动力学检查使得难以评估手术在导致这些功能障碍的确切作用。因此，至少在某些选定病例中，术前和随访期间进行尿动力学检查有助于对潜在功能障碍做出准确诊断，指明适当的治疗方法，并预防术后尿失禁的发生和发作。
