Department of Urology, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul, 137-040, Korea.
Int Urol Nephrol. 2013 Aug;45(4):989-94. doi: 10.1007/s11255-013-0475-2. Epub 2013 May 31.
Female voiding dysfunction lacks clear definitions or objective data even to this day due to the relatively low prevalence and complex etiologies of voiding dysfunction in women compared to men. The prevalence varies widely from 2.7 to 23 % (Nitti et al. in J Urol 161(5):1535-1540, 1999; Rees et al. in Br J Urol 47(7):853-860, 1975; Groutz et al. in Neurourol Urodyn 19(3):213-220, 2000; Farrar et al. in Br J Urol 47(7):815-822, 1975; Massey and Abrams in Br J Urol 61(1):36-39, 1988; Chassagne et al. in Urology 51(3):408-411, 1998). Diagnostic criteria and management of female voiding dysfunction have not yet been established. We performed a prospective, multi-center study at nine hospitals to investigate the characteristics and prevalence of female voiding dysfunction.
A total of 1,415 women visited urology clinics in nine hospitals from September to December 2005. Among them, 792 patients presented with lower urinary tract symptoms (LUTS). We analyzed their urinary symptoms with an International Prostate Symptom Score (IPSS) and obtained objective data using uroflowmetry, residual urine volume, and urinalysis. The authors hereby define female voiding dysfunction as maximum flow rate (Q max) of 15 ml/s or less, which may be due to either bladder outlet obstruction (BOO) or bladder dysfunction caused by detrusor underactivity. BOO was defined as Q max <15 ml/s with detrusor pressure >20 cmH2O at Q max, and detrusor underactivity was defined as Q max <15 ml/s with detrusor pressure <20 cmH2O at Q max on pressure flow studies.
Hundred and two patients (12.8 %) from a total of 792 LUTS patients complained of voiding difficulty. Mean total IPSS score, mean IPSS subscores for voiding and storage symptom was 19.5 ± 7.9, 12.0 ± 5.0, and 8.4 ± 3.4, respectively. Among the seven categories of IPSS, incomplete emptying was the most common symptom followed by weak stream. Eighty-nine patients (87.2 %) from a total of 102 voiding dysfunction patients showed BOO, while 13 patients (12.8 %) showed detrusor underactivity. Concomitant diseases observed with voiding dysfunctions were overactive bladder (32 patients), stress urinary incontinence (25), detrusor underactivity (13), previous stress urinary incontinence surgery (12), pelvic organ prolapse (4), and anatomical obstruction (3 patients).
The prevalence of voiding difficulty in female urology patients who visit urologic office clinic was 7.2 and 12.8 % in female LUTS patients. Voiding symptoms were more common than storage symptoms, while functional BOO was more prevalent than detrusor underactivity in female voiding difficulty patients. We may expect alpha blockers to be an effective treatment option in female voiding difficulty due to functional BOO.
与男性相比，女性排尿功能障碍的患病率较低，病因较为复杂，因此至今仍缺乏明确的定义或客观数据。女性排尿功能障碍的患病率差异很大，为 2.7%至 23%（Nitti 等人，J Urol 161(5):1535-1540, 1999；Rees 等人，Br J Urol 47(7):853-860, 1975；Groutz 等人，Neurourol Urodyn 19(3):213-220, 2000；Farrar 等人，Br J Urol 47(7):815-822, 1975；Massey 和 Abrams，Br J Urol 61(1):36-39, 1988；Chassagne 等人，Urology 51(3):408-411, 1998）。女性排尿功能障碍的诊断标准和治疗方法尚未确定。我们在九家医院进行了一项前瞻性、多中心研究，旨在调查女性排尿功能障碍的特征和患病率。
2005 年 9 月至 12 月期间，共有 1415 名女性到九家医院的泌尿科诊所就诊。其中，792 名患者出现下尿路症状（LUTS）。我们使用国际前列腺症状评分（IPSS）分析了她们的尿症状，并通过尿流率、残余尿量和尿液分析获得了客观数据。作者将女性排尿功能障碍定义为最大尿流率（Q max）为 15ml/s 或更低，这可能是由于膀胱出口梗阻（BOO）或逼尿肌功能障碍引起的膀胱功能障碍。BOO 定义为 Q max <15ml/s 时逼尿肌压力>20cmH2O，逼尿肌功能障碍定义为 Q max <15ml/s 时逼尿肌压力<20cmH2O 在压力流研究中。
在总共 792 名 LUTS 患者中，有 102 名（12.8%）患者抱怨排尿困难。总 IPSS 评分、排尿和储尿症状的平均 IPSS 评分分别为 19.5±7.9、12.0±5.0 和 8.4±3.4。在 IPSS 的七个类别中，不完全排空是最常见的症状，其次是弱流。在总共 102 名排尿功能障碍患者中，89 名（87.2%）患者表现为 BOO，13 名（12.8%）患者表现为逼尿肌功能障碍。伴有排尿功能障碍的并存疾病有：逼尿肌过度活动（32 例）、压力性尿失禁（25 例）、逼尿肌功能障碍（13 例）、既往压力性尿失禁手术（12 例）、盆腔器官脱垂（4 例）和解剖性梗阻（3 例）。
在泌尿科门诊就诊的女性 LUTS 患者中，排尿困难的患病率为 7.2%，女性 LUTS 患者中为 12.8%。排尿症状比储尿症状更常见，而女性排尿困难患者中功能性 BOO 比逼尿肌功能障碍更为常见。由于功能性 BOO，我们可能期望α受体阻滞剂成为女性排尿困难的有效治疗选择。
