医学课件女性尿道综合征宣教.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,DEFINITION,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,1986).,“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 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,implying 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 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,chronic 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,主要依靠,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,上运动神经元的损害 大量摄水,妊娠,膀胱结石,尿道肉阜,放射性膀胱炎 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,肾脏损害,尿道的萎缩性改变,逼尿肌不稳定,IC OAB 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,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,Thank you!,