Khorsandi M, Ginsberg P C, Harkaway R C
Division of Urology, Department of Surgery, Albert Einstein Medical Center and Moss Rehabilitation Hospital, Philadelphia, PA 19141, USA.
Urol Int. 1998;61(3):142-6. doi: 10.1159/000030310.
To determine whether there is a gender difference in the need for urodynamics in the evaluation of urinary incontinence after cerebrovascular accident (CVA).
We studied 72 consecutive post-CVA patients with new onset urinary incontinence documented by the patients or the persons who looked after them. Patients were evaluated between 4 and 6 weeks after their CVA and all had negative urine cultures and a postvoid residual urine determination. Exclusion criteria included narrow angle glaucoma, postvoid residual urine greater than 100 cm3 and radiographic evidence for a brainstem infarct. This left 30 male (mean age 65) and 30 female (mean age 67) patients evaluable. Patients were empirically started on anticholinergic medications and timed voids for 4 weeks after which cytoscopy and cystometry were performed.
28/30 females (93%) reported subjective improvement in their continence with conservative measures. 1 (3%) was found to have a urethral diverticulum, and 1 (3%) had uninhibited detrusor contractions that did not improve with medications. In the male group, 20/30 (67%) reported subjective improvement, 5 (17%) developed elevated postvoid residual urine volumes, 3 (10%) were diagnosed with urethral strictures, 1 (3%) had a bladder neck contracture, and 1 (3%) had transitional cell carcinoma in situ in the bladder.
In the patient with new onset urinary incontinence in the initial period after CVA, an empiric trial of anticholinergic medications and timed voiding may be warranted in a select population of female patients without urodynamic testing or cystoscopy. This conservative approach may not be appropriate in males because of their increased likelihood of having secondary urologic conditions.
确定在评估脑血管意外（CVA）后尿失禁时，尿动力学检查需求是否存在性别差异。
我们研究了72例连续性CVA后新发尿失禁患者，尿失禁由患者本人或其照料者记录。患者在CVA后4至6周接受评估，所有患者尿培养阴性且测定了残余尿量。排除标准包括闭角型青光眼、残余尿量大于100 cm³以及脑干梗死的影像学证据。最终有30例男性（平均年龄65岁）和30例女性（平均年龄67岁）患者可进行评估。患者经验性地开始使用抗胆碱能药物并定时排尿4周，之后进行膀胱镜检查和膀胱测压。
28/30例女性（93%）报告经保守治疗后尿失禁主观症状改善。1例（3%）发现有尿道憩室，1例（3%）有无抑制性逼尿肌收缩，药物治疗无效。在男性组中，20/30例（67%）报告主观症状改善，5例（17%）残余尿量增加，3例（10%）诊断为尿道狭窄，1例（3%）有膀胱颈挛缩，1例（3%）膀胱原位移行细胞癌。
对于CVA后初期新发尿失禁的患者，在部分女性患者中，可不进行尿动力学检查或膀胱镜检查，经验性试用抗胆碱能药物并定时排尿可能是合理的。由于男性发生继发性泌尿系统疾病的可能性增加，这种保守方法可能不适用于男性。
