Kim Sung Han, Kim Tae Beom, Kim Soo Woong, Oh Seung-June
Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea.
J Urol. 2009 Jun;181(6):2550-4. doi: 10.1016/j.juro.2009.01.106. Epub 2009 Apr 16.
In this study we identify the characteristics of the urodynamic results in patients with painful bladder syndrome/interstitial cystitis and in those with idiopathic overactive bladder.
The fluoroscopic urodynamic study results were analyzed retrospectively in 40 consecutive female patients with painful bladder syndrome/interstitial cystitis and 78 female patients with idiopathic overactive bladder between October 2005 and August 2007. Before treatment a symptom assessment, questionnaires, 3-day voiding diary and laboratory tests were performed at the initial outpatient clinic visit. All patients had been diagnosed and grouped according to painful bladder syndrome/interstitial cystitis or overactive bladder based on the clinical features before cystoscopy, potassium chloride sensitivity test and urodynamic investigation.
Mean (+/-SD) age of patients with painful bladder syndrome/interstitial cystitis and overactive bladder was 57.8 (+/-12.9) and 61.9 (+/-11.9) years, respectively. Maximum flow rate and voided volume based on free uroflowmetry were significantly different between the 2 groups (p <0.05). For the static urethral pressure profile there was a significant difference between the groups in terms of maximal urethral closing pressure and maximal urethral pressure (p <0.05). For filling cystometry the volumes at each interval (first desire, normal desire, strong desire) and the volumes at maximum cystometric capacity were significantly lower (p <0.001) in patients with painful bladder syndrome/interstitial cystitis, as was bladder compliance (p = 0.025). No involuntary detrusor contraction was observed in the painful bladder syndrome/interstitial cystitis group but it was observed in 53 patients (67.9%) with overactive bladder (chi-square p <0.001). There was no significant difference in maximal detrusor pressure on voiding and fluoroscopic results between the 2 groups (p >0.05). Logistic regression analysis after adjusting for age, symptom duration, number of major comorbidities and disease groups showed that all variables in the urethral pressure profile were not significantly different between the painful bladder syndrome/interstitial cystitis and overactive bladder groups.
This study showed that the urodynamic results were significantly different between the painful bladder syndrome/interstitial cystitis and overactive bladder groups. Combined with other clinical findings urodynamic studies might provide additional information to confirm a diagnosis of painful bladder syndrome/interstitial cystitis.
在本研究中，我们确定了疼痛性膀胱综合征/间质性膀胱炎患者以及特发性膀胱过度活动症患者的尿动力学结果特征。
回顾性分析了2005年10月至2007年8月期间连续的40例疼痛性膀胱综合征/间质性膀胱炎女性患者和78例特发性膀胱过度活动症女性患者的荧光透视尿动力学研究结果。在治疗前，于初次门诊就诊时进行症状评估、问卷调查、3天排尿日记及实验室检查。所有患者在膀胱镜检查、氯化钾敏感性试验及尿动力学检查前，已根据临床特征诊断并分为疼痛性膀胱综合征/间质性膀胱炎或膀胱过度活动症组。
疼痛性膀胱综合征/间质性膀胱炎患者和膀胱过度活动症患者的平均（±标准差）年龄分别为57.8（±12.9）岁和61.9（±11.9）岁。两组间基于自由尿流率测定的最大尿流率和排尿量有显著差异（p<0.05）。对于静态尿道压力分布图，两组间在最大尿道闭合压力和最大尿道压力方面存在显著差异（p<0.05）。对于膀胱容量测定，疼痛性膀胱综合征/间质性膀胱炎患者在每个间隔（首次排尿欲望、正常排尿欲望、强烈排尿欲望）时的容量以及最大膀胱容量时的容量均显著更低（p<0.001），膀胱顺应性也是如此（p = 0.025）。疼痛性膀胱综合征/间质性膀胱炎组未观察到逼尿肌不自主收缩，但在53例（67.9%）膀胱过度活动症患者中观察到了逼尿肌不自主收缩（卡方检验p<0.001）。两组间排尿时的最大逼尿肌压力及荧光透视结果无显著差异（p>0.05）。在对年龄、症状持续时间、主要合并症数量及疾病组进行校正后的逻辑回归分析显示，疼痛性膀胱综合征/间质性膀胱炎组和膀胱过度活动症组在尿道压力分布图中的所有变量均无显著差异。
本研究表明，疼痛性膀胱综合征/间质性膀胱炎组和膀胱过度活动症组的尿动力学结果存在显著差异。结合其他临床发现，尿动力学研究可能为确诊疼痛性膀胱综合征/间质性膀胱炎提供更多信息。
