Juma Saad
Incontinence Research Institute, Encinitas, California, USA.
Curr Opin Urol. 2014 Jul;24(4):375-9. doi: 10.1097/MOU.0000000000000071.
This review is a summary of the most pertinent published studies in the literature in the last 18 months that address cause, diagnosis, and management of urinary retention in women.
Symptoms, uroflow, and pressure-flow studies have a low predictive value for and do not correlate with elevated postvoid residual urine (PVR). Anterior and posterior colporrhaphy do not cause de-novo bladder outlet obstruction in the majority of patients with elevated PVR, and the cause of elevated PVR may be other factors such as pain or anxiety causing abnormal relaxation of the pelvic floor and contributing to voiding difficulty. The risk of urinary retention in a future pregnancy after mid-urethral sling (MUS) is small. The risk of urinary tract infection and urinary retention after chemodenervation of the bladder with onabotulinumtoxin-A (100 IU) in patients with non-neurogenic urge incontinence is 33 and 5%, respectively. There is a lack of consensus among experts on the timing of sling takedown in the management of acute urinary retention following MUS procedures.
There has been a significant progress in the understanding of the causation of urinary retention. Important areas that need further research (basic and clinical) are post-MUS and pelvic organ prolapse repair urinary retention and obstruction, and urinary retention owing to detrusor underactivity.
本综述总结了过去18个月文献中关于女性尿潴留病因、诊断及管理的最相关已发表研究。
症状、尿流率及压力-流率研究对排尿后残余尿量（PVR）升高的预测价值较低，且与之无相关性。在大多数PVR升高的患者中，前后阴道壁修补术不会导致新发膀胱出口梗阻，PVR升高的原因可能是其他因素，如疼痛或焦虑导致盆底异常松弛并导致排尿困难。中段尿道吊带术（MUS）后未来妊娠发生尿潴留的风险较小。在非神经源性急迫性尿失禁患者中，使用A型肉毒毒素（100 IU）进行膀胱化学去神经支配后，尿路感染和尿潴留的风险分别为33%和5%。在MUS手术后急性尿潴留的管理中，专家们对于吊带拆除的时机缺乏共识。
在尿潴留病因的理解方面取得了重大进展。需要进一步研究（基础和临床）的重要领域是MUS术后和盆腔器官脱垂修复后的尿潴留和梗阻，以及逼尿肌活动不足导致的尿潴留。
