Farrell S A, Tynski G
Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada.
Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):87-93. doi: 10.1007/BF01902379.
The purposes of this study were to confirm previously described patterns of urethral pressure variation and to establish criteria for their diagnosis. The effect of urethral pressure variation on detrusor activity was also examined. The study involved a retrospective review of the computerized cystometric tracings from a 26-month period. Forty-one patients had artefact-free satisfactory tracings demonstrating urethral pressure variation, detrusor instability and/or gradual detrusor pressure increase. These tracings were stored on a computer program which permitted real-time second-by-second review. Statistical analysis was done using Fisher's exact test and an independent t-test. Three patterns of urethral pressure variation were identified: rapid pressure variation (RPV), gradual pressure variation (GPV) and stress-induced transient urethral relaxation (SITUR). RPV was associated with onset at low bladder volumes (independent t-test, P = 0.02) and with detrusor instability (Fisher's exact test, P < 0.001). GPV began at high bladder volumes (Fisher's exact test, P < 0.001). SITUR was not associated with any specific pattern of urethral pressure variation or detrusor pressure change. Analysis of tracings of the patients with a combination of rapid urethral pressure variation and detrusor instability revealed a statistically significant increased frequency of urethral relaxation as the primary event precipitating an unstable detrusor contraction (Fisher's exact test, P < 0.003). In conclusion, three different patterns of urethral pressure variation were identified. Rapid pattern of urethral pressure variation is closely associated with detrusor instability. Further study of urethral pressure variation may help to elucidate the pathophysiologic mechanism responsible for idiopathic unstable detrusor contractions.
本研究的目的是确认先前描述的尿道压力变化模式，并建立其诊断标准。同时还研究了尿道压力变化对逼尿肌活动的影响。该研究回顾了26个月期间的计算机化膀胱测压记录。41例患者的记录无伪差且令人满意，显示出尿道压力变化、逼尿肌不稳定和/或逼尿肌压力逐渐升高。这些记录存储在一个允许逐秒实时查看的计算机程序中。采用Fisher精确检验和独立t检验进行统计分析。识别出三种尿道压力变化模式：快速压力变化（RPV）、逐渐压力变化（GPV）和应力诱发的短暂尿道松弛（SITUR）。RPV与低膀胱容量时发作相关（独立t检验，P = 0.02），且与逼尿肌不稳定相关（Fisher精确检验，P < 0.001）。GPV始于高膀胱容量（Fisher精确检验，P < 0.001）。SITUR与尿道压力变化或逼尿肌压力变化的任何特定模式均无关。对快速尿道压力变化和逼尿肌不稳定合并患者的记录分析显示，作为引发逼尿肌不稳定收缩的主要事件，尿道松弛频率在统计学上显著增加（Fisher精确检验，P < 0.003）。总之，识别出三种不同的尿道压力变化模式。快速尿道压力变化模式与逼尿肌不稳定密切相关。对尿道压力变化的进一步研究可能有助于阐明特发性逼尿肌不稳定收缩的病理生理机制。
