女性尿道综合征

.,FemaleUrethralSyndromeFUS,yangfei,.,DEFINITION,In1945,thedistinguishedAmericanphysicianRichardCabotwasquotedashavingstatedthat“anypainwithintwofeetofthefemaleurethraforwhichonecannotfindanadequateexplanationshouldbesuspectedofcomingfromthefemaleurethra”(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”。,.,Thetermurethralsyndromewasfirstmentionedinaclinicopathologicstudyofthefemaleurethrain1949.ItappearedintheBritishliteraturein1965whenagroupofNewZealandphysiciansusedittodescribethe50%oftheirfemalepatientswithurinarysymptomswithoutdemonstrableinfection.,.,ClinicalManifestation,FUSisaverynonspecificconstellationofsymptomsincludingurinaryfrequency,urgency,dysuria,andsuprapubicdiscomfortwithoutanyobjectivefindingsofurologicabnormalitytoaccountforthesymptoms.(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)Althoughthesymptomsaretypicallythoughttooccurinwomen,thereisnoreasontoassumethatasimilarentitydoesnotoccurinmen(其常见于女性患者，但也不能排除在男性患者中的存在),.,Classification,Theurethralsyndromehasbeensubdividedintoanacuteandachroniccondition.,.,acuteurethralsyndrome,implyingasitdoesamysteriouscauseandaurethraloriginofthemalady,haslargelybeenabandonedinfavorofidentifiableetiologicdiagnoses.manyofwhicharefoundinthechaptersonurinarytractinfectionandSTD.Onlyarelativelysmallpercentageofpatientswithacuteurethralsyndromearefoundoninvestigationtohavenocauseforthesymptoms.Itwouldbemoreaccuratetocategorizethisgroupofpatientsbytheirsymptomsthantogivethemadiagnosisof“acuteurethralsyndrome,”whichultimatelycommunicateslittleaboutthedisorder.,.,chronicurethralsyndrome,Thosepatientswithchronicsymptomsandwithnoapparentcauseconstitutethechronicurethralsyndromecategory.Thisphantomdiagnosisisoneofexclusionandisrarelyusedinmodernurologictexts.ThesymptomaticmanifestationsofICandthechronicurethralsyndromeareindistinguishable.,.,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。,.,Theconceptoftheurethralsyndrome,chronicoracute,isnowessentiallyahistoricaloneandnolongeralludedtointhemodernmedicalliterature。,.,CausesofFrequencyandUrgency,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ICOAB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