Is Nocturia Associated With Detrusor Underactivity?
Is Nocturia Associated With Detrusor Underactivity?
复制标题
夜尿症与逼尿肌活动不足有关吗？
DOI：
10.1097/spv.0000000000001035
复制
发表时间：
2021-09-01
影响因子：
1.6
通讯作者：
Arya LA
中科院分区：
文献类型：
--
作者：
Ryles HT;Sansone SA;Levin PJ;Andy UU;Harvie HS;Arya LA
逼尿肌活动不足是通过尿动力学检查来诊断的。我们假设膀胱尿失禁与逼尿肌活动不足有关。我们对2016年至2018年期间在我们机构接受尿动力学检查的所有女性进行了回顾性图表审查。比较了有排尿困难（≥ 2次排尿/夜）和无排尿困难（0-1次排尿/夜）女性的尿流率和压力-流量研究参数。逼尿肌活动不足的诊断采用三种不同的标准：膀胱排尿效率<90%，膀胱收缩指数< 100，以及三种尿动力学指标的复合（Gammie标准）。在358名女性中，172名（48%）属于月经不调组，186名（52%）属于无月经不调组。在尿流率测定中，两组的中位排尿后残留量相似（20 mL）。与无尿失禁组相比，尿失禁组的中位最大流速（15与17 mL/s，p < 0.05）和平均流速（6 mL/s与7 mL/s，p < 0.05）显著降低。在压力-流量研究中，有显著更大比例的女性患者不能在导管周围排尿（30%对27%，p < 0.01）。逼尿肌活动不足的总体发生率随所用标准而变化：膀胱排尿效率（54%）、膀胱收缩指数（41%）和Gammie标准（7%）。使用膀胱排尿效率标准的逼尿肌活动不足率在排尿困难组中显著较高（63%对48%，p < 0.01），但使用其他标准没有显著差异。夜尿症与女性排尿效率降低有关。使用尿动力学诊断逼尿肌活动不足具有挑战性。
Detrusor underactivity is diagnosed using urodynamic testing. We hypothesized that nocturia is associated with detrusor underactivity. We performed a retrospective chart review of all women who underwent urodynamic testing at our institution between 2016 and 2018. Uroflowmetry and pressure-flow study parameters were compared between women with nocturia (≥ 2 voids/night) and without nocturia (0–1 void/night). Detrusor underactivity was diagnosed using three different criteria: Bladder voiding efficiency < 90%, bladder contractility index < 100, and a composite of three urodynamic measures (Gammie criteria). Of 358 women, 172 (48%) were in the nocturia group and 186 (52%) in the no nocturia group. On uroflowmetry, median postvoid residual volume was similar (20 mL) in both groups. Median maximum flow rate (15 versus 17 mL/s, p < 0.05) and average flow rate (6 mL/s versus 7 mL/s, p < 0.05) were significantly lower in the nocturia compared to the no nocturia group. During pressure-flow study, a significantly greater proportion of women with nocturia were unable to void around the catheter (30% versus 27%, p < 0.01). The overall rate of detrusor underactivity varied with the criteria used: bladder voiding efficiency (54%), bladder contractility index (41%), and Gammie criteria (7%). The rate of detrusor underactivity using bladder voiding efficiency criteria was significantly higher in the nocturia group (63% versus 48%, p < 0.01), but no significant differences were noted using the other criteria. Nocturia is associated with reduced voiding efficiency in women. The diagnosis of detrusor underactivity using urodynamics is challenging.