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女性慢性尿潴留

Author
Leslie M Rickey, MD, MPH
Section Editor
Linda Brubaker, MD, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
古迪, 主治医师

引言

慢性尿潴留(chronic urinary retention, CUR)是指由膀胱排空不完全或不充分造成的膀胱内尿液蓄积。最常用排尿后膀胱内的剩余尿量(又称排泄后残余尿量)来描述和测量膀胱排空不完全。CUR的两个常见原因是膀胱肌肉功能障碍[逼尿肌活动低下(detrusor underactivity, DU)]和梗阻。CUR通常是一个渐进的过程。

本专题将总结女性CUR的病因、评估和治疗选择。急性尿潴留和术后尿潴留的问题将单独讨论。 (参见“急性尿潴留”和“女性术后尿潴留”)

定义

有临床意义的CUR是指在缺乏干预的情况下引起不良临床结局的尿液蓄积[1]。通常通过测量排泄后残余尿量(postvoid residual urine volume, PVR)来确定CUR。国际尿控协会将PVR定义为排尿完成后膀胱内的剩余尿量[2]。虽然尚无定义CUR的标准PVR，但是常用大于150mL的PVR。 (参见下文‘诊断’)

虽然尚无区分慢性和急性尿潴留的标准时间范围，但是当女性持续6-8周以上出现异常的PVR时，有理由认为是CUR。

病理生理学

正常排尿需要协调的尿道和盆底肌松弛，然后膀胱收缩[2]。其中任何环节中断都会导致尿潴留。脑桥排尿中枢触发排尿反射，通过腹下神经的交感神经支配引起尿道外括约肌(横纹肌)松弛，并通过阴部神经的躯体神经支配引起盆底肌松弛(图 1)[3]，造成尿道压力下降，然后来自盆丛的副交感神经支配介导出现膀胱逼尿肌收缩。膀胱排空不完全可由上述路径任何位置的异常功能或出口水平梗阻引起。

                                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-22.
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