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1 尿流動力暨影像檢查系統 (Video-urodynamics )介紹 奇美醫院 婦女泌尿暨骨盆重建醫學 吳銘斌醫師 下泌尿道(lower urinary tract, LUT)包括膀胱、尿道、骨盆底肌肉、附近支撐的筋膜 及韌帶,成為一個整合的系統。膀胱尿液的灌注(filling)、儲尿(storage)及解尿(voiding) 並非處於一個靜止(static)狀態,而是一個動態的過程(dynamic process)。因此,要檢 查下泌尿道在灌注、儲尿及解尿的功能時,也需要一種動態(dynamic)的檢查方法。因 此對於下泌尿道功能障礙的病人,為了找出病灶探查病因,以得到正確的診斷與治療, 除了詳細病史、理學神經學檢查、及實驗室檢驗外、尿流動力學檢查(urodynamic study) 是必備的檢查項目。正常儲尿期,下泌尿道處於低膀胱壓及高尿道壓;而解尿期,下泌 尿道處於低尿道壓及中度膀胱壓,形成協同作用 (如圖一) 圖一:正常儲尿(storage)解尿(voiding)圖示。A:正常儲尿期,下泌尿道處於低膀胱壓 及高尿道壓;B:而解尿期,下泌尿道處於低尿道壓及中度膀胱壓,形成協同作 用。 一般的臨床尿流動力學檢查包括了以下幾項,可單獨進行或合併多項進行: 尿流速圖(Uroflowmetry, UFR) 膀胱壓檢查 (Cystometry, CMG)。與外括約肌肌電圖 (External sphincter electromyogram, EMG)配合檢查 壓力尿流速圖(Pressure-flow study, PFS)

尿流動力暨影像檢查系統 (Video-urodynamics ) 介紹 · 5 electromyogram, EMG) 。A:正常灌注時逼尿肌壓(Pdet)不會有明顯壓力上升的 情況(

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(Video-urodynamics )

(lower urinary tract, LUT)

(filling)(storage)(voiding)

(static)(dynamic process)

(dynamic)

(urodynamic study)

()

(storage)(voiding)A

B

(Uroflowmetry, UFR)

(Cystometry, CMG) (External sphincter

electromyogram, EMG)

(Pressure-flow study, PFS)

2

(Urethral pressure profile study, UPP)

(Stress urethral pressure profile, stress UPP)

Uroflowmetry (UFR) ()

(detrusor)

1. maximum flow rate, Qmax 25ml/sec

2. average flow rate, Qave 10-20ml/sec

3. voided volume, VV200ml

4. voiding time 15-20sec

5. time to maximum flow about 10 sec

6. postvoided residual, PVR; or residual urine, RU50ml (

< 100ml)

A

DC

B

(Uroflowmetry, UFR) A(normal pattern)

B(intermittent interrupted pattern)

3

(abdominal straining)C(bladder

outlet obstructcion, BOO)D

(abdominal straining)

(bladder outlet obstructcion, BOO)

(Cystometry, CMG) ()

(External sphincter electromyogram, EMG)

(filling)

(compliance)

(Valsalva maneuver)(detrusor pressure,

Pedt15cmH2O)(stress urinary incontinence)

1. (first desire to void, FD): 150ml

2. (normal desire to void, ND): 250ml

3. (strong desire to void, SD): 350ml

4. (urgency):

5. (maximum cystometric capacity, MCC): 400-600ml

(interstitial cystitis, IC)

(bladder outlet obstruction)

(urodynamic stress incontinence)(detrusor overactivity, DO)

(low compliant bladder)

(Pves)(Pabd)(Pdet)

[(Pdet)= (Pves) -- (Pabd)]

4

A B

C

(Cystometry, CMG) (External sphincter

5

electromyogram, EMG)A(Pdet)

(

6

(MUCP= Pura Pves)

3. (Functional urethral length, FUL

4. (Pressure transmission ratio, PTR)(sUPP)

(Pura)(Pves)(Pura/ Pves)

PTR (MUCP)

20cmH2O

MUCP FUL

UPP

A B

(Urethral pressure profile study, UPP)

(Stress urethral pressure profile, sUPP)A

(MUCP)B(MUCP)

7

(Urodynamic stress incontinence USI)

()(Detrusor overactivity with/ without incontinence)

(Mixed urinary incontinence, USI + DO)

(Increased bladder sensation)

(Low compliant bladder)

(Underactive/ Acontractile detrusor)

(Bladder outlet obstruction)

(Detrusor sphincter dyssynergia, DSD)

(Video-urodynamics )

1. (pressure flow study)

(

) ()

()

2.

3. :

(1) (equivocal results)

(2)

(3) spinal cord injury, detrusor-sphincter

dyssynergia, neurogenic bladder

(4) uretrhal stenosis, veso-ureteric reflex

(5) (lower urinary tract dysfunction, LUTD)

8

()(

)