Hilton P
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Br J Urol. 1998 Apr;81(4):539-42. doi: 10.1046/j.1464-410x.1998.00596.x.
To assess the feasibility of carrying out a urodynamic investigation in patients with a urogenital fistula and to establish the incidence of abnormal lower urinary tract function in such patients.
Of 38 patients referred within the last 3 years with a diagnosis of lower urinary tract genital fistula, 30 were investigated by dual-channel subtracted cystometry before surgical treatment of their fistula; in addition, urethral pressure profilometry was carried out in 19 patients. Fourteen of the patients had fistulae into the vaginal vault; the urodynamic findings in this subgroup were compared with those of 12 patients with bladder neck and urethrovaginal fistulae. Twenty-six of the 30 patients underwent surgical treatment and 24 (92%) were cured anatomically by their first procedure. Ten patients complained of residual lower urinary tract symptoms and were re-investigated.
Of the 38 patients, 47% had genuine stress incontinence, 40% showed systolic detrusor instability and 17% impaired bladder compliance. Half had evidence of voiding dysfunction; most appeared to be of a hypotonic detrusor type, although four cases showed an obstructive pattern. Fifteen patients had more than one abnormality and only five (17%) had entirely normal urodynamic findings. The overall incidence of functional abnormality was highest in the patients with urethral or bladder neck fistulae, with only one showing entirely normal urodynamic findings. Genuine stress incontinence was found more than twice as often associated with urethral or bladder neck fistulae and detrusor instability was also more common in this group. Voiding dysfunction of both hypotonic and obstructive types was found equally in the two groups. After surgical treatment, most patients became continent and free from lower urinary tract symptoms, although one complained of residual stress incontinence and nine of urgency or urge incontinence. Of the latter, six were found to have detrusor instability, one after repair of vault fistula, three after urethral or bladder neck fistulae and the other two after mid-vaginal fistulae.
There is a high incidence of abnormal lower urinary tract function in patients with urogenital fistulae. Patients with urethral or bladder neck fistulae had a higher incidence of both detrusor instability and genuine stress incontinence than those with fistulae into the vaginal vault. Many of these abnormalities appear to resolve after successful repair of the fistula, although detrusor instability may persist and require further treatment in some women. These findings are relevant to the counselling of patients before repair and may be of medico-legal significance.
评估对泌尿生殖瘘患者进行尿动力学检查的可行性，并确定此类患者下尿路功能异常的发生率。
在过去3年中确诊为下尿路生殖瘘的38例患者中，30例在瘘管手术治疗前接受了双通道减法膀胱测压检查；此外，19例患者进行了尿道压力测定。14例患者的瘘管通向阴道穹窿；将该亚组的尿动力学检查结果与12例膀胱颈和尿道阴道瘘患者的结果进行比较。30例患者中的26例接受了手术治疗，24例（92%）首次手术即获得解剖学治愈。10例患者主诉有下尿路残余症状，遂再次接受检查。
38例患者中，47%有真性压力性尿失禁，40%表现为逼尿肌收缩期不稳定，17%膀胱顺应性受损。半数患者有排尿功能障碍的证据；多数表现为逼尿肌低张型，尽管有4例表现为梗阻型。15例患者有不止一种异常，只有5例（17%）尿动力学检查结果完全正常。尿道或膀胱颈瘘患者功能异常的总体发生率最高，只有1例尿动力学检查结果完全正常。尿道或膀胱颈瘘患者真性压力性尿失禁的发生率是前者的两倍多，逼尿肌不稳定在该组也更常见。低张型和梗阻型排尿功能障碍在两组中出现的频率相同。手术治疗后，大多数患者实现了控尿且无下尿路症状，尽管有1例主诉有残余压力性尿失禁，9例主诉有尿急或急迫性尿失禁。在后者中，6例被发现有逼尿肌不稳定，1例在阴道穹窿瘘修复后出现，3例在尿道或膀胱颈瘘修复后出现，另外2例在阴道中段瘘修复后出现。
泌尿生殖瘘患者下尿路功能异常的发生率很高。尿道或膀胱颈瘘患者逼尿肌不稳定和真性压力性尿失禁的发生率高于瘘管通向阴道穹窿的患者。尽管逼尿肌不稳定可能持续存在，部分女性需要进一步治疗，但瘘管成功修复后，许多此类异常情况似乎会得到缓解。这些发现与修复手术前对患者的咨询相关，可能具有法医学意义。
