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中華民國泌尿科醫學會雜誌

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篇名 女性尿滯留
卷期 7:3
並列篇名 Urinary Retention in the Females
作者 楊緒棣劉建廷
頁次 138-142
關鍵字 尿滯留手術併發症尿動力學urinary retentionsurgical complicationurodynamicsTSCI
出刊日期 199609

中文摘要

女性尿滯留並非罕見,七年之間我們一共經歷了四十七例,其潛在病因和男性病患有所不同;最常見為外骨科術後併發症,其次依序為脊椎壓迫性骨折,子宮頸癌,腦中風,糖尿病末期,精神科疾病等。在診斷上必需作尿動力學的檢查,以做為將來處理的依據。不可以因潛在疾病可能會影響膀胱神經功能而放棄積極的治療。在處理上以間歇性導尿為主,再輔以藥物。經以上處置百分七十的病人可以恢復正常排尿功能。研究發現第一次尿滯留量大於600毫升會延長膀胱功能的恢復時間。因此醫師與護士對此問題的了解與注意,才是最好的預防之道。

英文摘要

Urinary retention in the females is not uncommon, but the results of management have usually not been satisfactory. In the past 7 years, 47 female patients with recurrent urinary retention (mean age: 65.4 years old) have been seen here. The underlying diseases of these female patients were post-operative complications, spine compression fracture, cervical cancer, cerebral vascular accident, diabetes mellitus and psychiatric diseases. Complete history taking, physical examinations (especially neurological examinations), initial catheterizing volume, and urodynamic studies were performed for evaluation of bladder function. The patients were further classified as Group A: normal detrusor contraction in cystometrogram(CMG) with simultaneous relaxation of electromyaogram(EMG); Group B: normal detrusor function in CMG with no relaxation or increased activity in EMG; Group C: no active detrusor contraction detected in CMG with good compliance: Group D: poor compliant bladder with no active detrusor function. The primary management of recurrent urinary retention is modifed intermittent catheterization program(ICP): three times to four times a day and Foely catheterization in the night. Normal voiding is defined as spontaneous voiding with residual urine less than 100 ml in two consecutive examinations. All the Group A patients could void normally; 50% of Group B patients and 57% of Group C patients could void normally after the above management. However, none of Group D patients could void normally in spite of ICP training. Initial catheterization volume was an important factor in predicting the time necessary for ICP training. For patients with no evident neurologic deficit, the mean time of ICP training was 5.4 days for initial retention volume less than 600 ml; and 13.5 days for a volume greater than 600 ml. Most(70%) of the female urinary retention could be managed simply by ICP training. Urodynamic study is helpful in predicting the results of training. Alpha-adrenergic blockers were used to prevent post-operative urinary retention according to many reports, but the awareness of physicians and nurses to signs of urinary retention may be even more important in the prevention and early treatment of female urinary retention.