Kira Satoru, Mitsui Takahiko, Kobayashi Hideki, Haneda Yaburu, Sawada Norifumi, Takeda Masayuki
Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Int Urogynecol J. 2017 May;28(5):783-787. doi: 10.1007/s00192-016-3203-5. Epub 2016 Dec 20.
To investigate detrusor pressure during voiding in women using urodynamic studies (UDS).
The study group comprised 57 women with non-neurogenic lower urinary tract symptoms. All patients underwent UDS between January 2010 and December 2014. UDS included filling cystometry, pressure flow study (PFS), uroflowmetry for the maximum flow rate (Qmax) and mean flow rate, and postvoid residuals. Existence of voluntary detrusor contraction was defined as a continuous and smooth increase in detrusor pressure (Pdet) after the instruction to micturate in the PFS. The bladder contractility index (BCI) was calculated as Pdet at Qmax + 5 × Qmax. Statistical analyses were performed using the Mann-Whitney U test and p < 0.05 was considered statistically significant.
The PFS showed that 23 patients had detrusor contraction (Pdet+ group) and 34 patients had no detrusor contraction (Pdet- group) during voiding. There were no significant differences in urodynamic parameters between the Pdet+ and Pdet- groups except in Pdet at Qmax and BCI. In the Pdet- group, 21 patients showed an increase in abdominal pressure during voiding (Pabd+ group), while the other 13 patients did not (Pabd- group). There were no differences in any of the urodynamic parameters between the Pabd+ and Pabd- groups.
Based on UDS, an increase in detrusor or abdominal pressure may not be necessary in micturition in women. The present study suggests that relaxation of pelvic floor muscles including normal urethral function are important for micturition in women.
通过尿动力学研究（UDS）来调查女性排尿时的逼尿肌压力。
研究组包括57名患有非神经源性下尿路症状的女性。所有患者在2010年1月至2014年12月期间接受了尿动力学检查。尿动力学检查包括充盈性膀胱测压、压力流率研究（PFS）、测量最大尿流率（Qmax）和平均尿流率的尿流率测定以及排尿后残余尿量测定。在压力流率研究中，自主逼尿肌收缩的存在定义为在接到排尿指令后逼尿肌压力（Pdet）持续且平稳地升高。膀胱收缩力指数（BCI）的计算方法为Qmax时的Pdet加上5乘以Qmax。采用Mann-Whitney U检验进行统计分析，p<0.05被认为具有统计学意义。
压力流率研究显示，23名患者在排尿时有逼尿肌收缩（Pdet+组），34名患者在排尿时无逼尿肌收缩（Pdet-组）。除了Qmax时的Pdet和BCI外，Pdet+组和Pdet-组的尿动力学参数没有显著差异。在Pdet-组中，21名患者在排尿时腹压升高（Pabd+组），而其他13名患者则没有（Pabd-组）。Pabd+组和Pabd-组的任何尿动力学参数均无差异。
基于尿动力学研究，女性排尿时可能无需逼尿肌或腹压升高。本研究表明，包括正常尿道功能在内的盆底肌肉松弛对女性排尿很重要。
