女性尿道综合征课件-.ppt

1、Female Urethral SyndromeFUSyangfeiDEFINITION In 1945,the distinguished American physician Richard Cabot was quoted as having stated that“any pain within two feet of the female urethra for which one cannot find an adequate explanation should be suspected of coming from the female urethra”(Charlton,19

2、86).“在女性尿道周围二英尺范围内的任何无法解释的疼痛都应考虑到是否来自于尿道的可能”。The term urethral syndrome was first mentioned in a clinicopathologic study of the female urethra in 1949.It appeared in the British literature in 1965 when a group of New Zealand physicians used it to describe the 50%of their female patients with urinary

3、 symptoms without demonstrable infection.Clinical Manifestation FUS is a very nonspecific constellation of symptoms including urinary frequency,urgency,dysuria,and suprapubic discomfort without any objective findings of urologic abnormality to account for the symptoms.(尿道综合症临床表现为包括尿频、尿急、排尿障碍以及耻骨上区不适

4、等一系列的症候群，且缺乏相关病理证据)Although the symptoms are typically thought to occur in women,there is no reason to assume that a similar entity does not occur in men(其常见于女性患者，但也不能排除在男性患者中的存在)Classification The urethral syndrome has been subdivided into an acute and a chronic condition.acute urethral syndrome im

5、plying as it does a mysterious cause and a urethral origin of the malady,has largely been abandoned in favor of identifiable etiologic diagnoses.many of which are found in the chapters on urinary tract infection and STD.Only a relatively small percentage of patients with acute urethral syndrome are

6、found on investigation to have no cause for the symptoms.It would be more accurate to categorize this group of patients by their symptoms than to give them a diagnosis of“acute urethral syndrome,”which ultimately communicates little about the disorder.chronic urethral syndrome Those patients with ch

7、ronic symptoms and with no apparent cause constitute the chronic urethral syndrome category.This phantom diagnosis is one of exclusion and is rarely used in modern urologic texts.The symptomatic manifestations of IC and the chronic urethral syndrome are indistinguishable.diagnosis 尿道综合症的诊断诊断主要依靠排除诊断

8、排除诊断。要诊断尿道综合症前必须排除间质性膀胱炎的存在。尿常规、中段尿细菌培养、细胞学检查以及在麻醉下膀胱镜检查的结果常常表现为阴性。夜尿可表现异常。The concept of the urethral syndrome,chronic or acute,is now essentially a historical one and no longer alluded to in the modern medical literature。Causes of Frequency and Urgency 尿路感染尿路感染 上运动神经元的损害 大量摄水妊娠妊娠 膀胱结石 尿道肉阜尿道肉阜放射性膀

9、胱炎 大量剩余尿 生殖器疣糖尿病 宫颈炎 尿道周围腺体的感染化学性刺激（环磷酰胺、避孕套及膀胱灌洗）尿崩症 外阴癌 膀胱癌 盆腔肿块利尿剂的应用 化疗 尿道憩室尿道憩室肾脏损害 尿道的萎缩性改变尿道的萎缩性改变 逼尿逼尿肌不稳定肌不稳定IC OAB IC OAB 细菌性尿道炎细菌性尿道炎etiology 1、排尿控制功能发育不全及退化 2、膀胱尿道肌肉痉挛 3、尿道外口因素：尿道外口距阴道口过近 尿道梗阻 4、精神原因 5、雌激素水平下降 6、机械因素 7、过敏或化学性激惹etiology 体内激素平衡紊乱、周围环境刺激影响以及变态反应等学说曾被提出，但都未被广泛接受。此外有学者认为可能与尿道

10、狭窄尿道狭窄有关，据报道经尿道扩张后症状有所缓解。但是，组织学研究认为尿道周围纤维化不具有可重复性，况且临床上真正有尿道狭窄的情况很少见。神经性因素和心理性因素也曾被提出，但这些病例有着较多争议。etiology 如果患者经严格的检查证实尿液无菌，细胞学检查阴性，那解剖因素、感染因素、炎症因素或神经源性因素的可能性就相对小了；要考虑是否有心理性因素心理性因素的存在，或者间质性膀胱炎的可能。在临床工作中，我们发现，以尿频、尿急为主诉的大多数女性患者，是可以发现引起患者尿频尿急的病因，如上所述。由此，我们可以针对尿频尿急患者制定一个诊疗流程，进行规范化诊断与治疗。尿频尿急询问病史及24小时排尿情况摄水过多药物或糖尿病引起有无神经系统病史神经源性尿常规、中断尿细菌培养尿路感染引起B超、体查等辅查结石、肿瘤引起尿道肉阜处女膜伞等膀胱镜检查IC，憩室，尿道旁腺感染等有无焦虑症或心理上疾病精神因素引起尿流动力学检查不能找到病因确立尿道综合症的诊断逼尿肌不稳定