Rodrigues Paulo, Hering Flávio, Dias Eli Cielici
Division of Neurourology and Voiding Disturbances, Beneficência Portuguesa Hospital of São Paulo, São Paulo, Brazil.
Int Urogynecol J. 2013 Feb;24(2):331-6. doi: 10.1007/s00192-012-1869-x. Epub 2012 Jul 3.
The aim of this study is to report a novel understanding of the urodynamic parameters used to diagnose iatrogenic female obstruction. There is no consensual definition of infravesical obstruction in women. Numerous criteria were designed with arbitrary cutoff values with poor clinical correlation. In order to determine the urodynamic profile of infravesical female obstruction we restricted our analysis to women who acquired voiding disturbances after being submitted to stress urinary incontinence (SUI) surgery.
A total of 302 women developed obstructive symptoms or voiding difficulties after SUI operations: 176 cases had had Kelly-Kennedy operations (58.2 %), 50 had had Burch operations (16.5 %), 37 (12.2 %) had had anterior colporrhaphy + abdominal (Burch) operations, 33 (10.9 %) had had sling operations, and 8 (2.6 %) had had Marshall-Marchetti operations. Obstructive urinary symptoms started in 1-120 days after the operation and urodynamic evaluations were done after various periods of time (median 18.4 months). Clinical presentations varied widely with irritative symptoms predominating the picture.
Five patterns of pressure-flow relationships could be identified: (1) elevated pressure and poor flow (7.2 %), (2) normal pressure and poor flow (41.5 %), (3) normal pressure and flow associated with prolonged flow time (24.2 %), (4) poor detrusor contraction and elevated residual volume (12.9 %), and (5) elevated pressure and high flow (14.5 %). No relationship was established amongst the group and the Urinary Distress Inventory questionnaire.
Infravesical obstruction in women does not fit a single model. As suggested, obstruction in women must be based on broad clinical pictures and urinary complaints.
本研究旨在报告对用于诊断医源性女性梗阻的尿动力学参数的全新认识。目前对于女性膀胱颈以下梗阻尚无统一的定义。众多诊断标准是通过任意设定的临界值制定的，与临床的相关性较差。为了确定膀胱颈以下女性梗阻的尿动力学特征，我们将分析局限于那些在接受压力性尿失禁（SUI）手术后出现排尿障碍的女性。
共有302名女性在SUI手术后出现梗阻症状或排尿困难：176例接受了凯利 - 肯尼迪手术（58.2%），50例接受了伯奇手术（16.5%），37例（12.2%）接受了前阴道壁修补术 + 腹部（伯奇）手术，33例（10.9%）接受了吊带手术，8例（2.6%）接受了马歇尔 - 马凯蒂手术。梗阻性尿路症状在术后1至120天出现，尿动力学评估在不同时间段进行（中位数为18.4个月）。临床表现差异很大，以刺激性症状为主。
可识别出五种压力 - 流量关系模式：（1）压力升高且流量不佳（7.2%），（2）压力正常且流量不佳（41.5%），（3）压力正常且流量与排尿时间延长相关（24.2%），（4）逼尿肌收缩功能差且残余尿量增加（12.9%），以及（5）压力升高且流量高（14.5%）。该组与尿失禁困扰量表问卷之间未建立关联。
女性膀胱颈以下梗阻并不符合单一模式。正如所建议的，女性梗阻必须基于广泛的临床表现和尿路症状。
