小结
定义
病史和体格检查
关键诊断因素
- 50 岁以上
- BMI 超过 25
- 产次增加
- 活动、用力、喷嚏、咳嗽时不自主漏尿
- 出现尿急感觉然后发生不自主漏尿或漏尿时伴有尿急的感觉
- 尿频
- 夜尿
- 使用可能导致尿失禁的药物
其他诊断因素
- 建议行排尿日记
- 阴道膨出
- 泌尿生殖道萎缩
- 子宫脱垂或后部支撑组织无力
- 居住在长期护理机构
- 慢性心力衰竭
- 糖尿病
- 过量饮水
- 精神状态检查发现认知损害
- 神经系统疾病史
- 背部损伤史
- 复发性泌尿道感染史
- 排尿困难
- 血尿
- 尿后滴沥
- 阴道中漏尿
- 尿道分泌物或压痛
- 增大的子宫
- 会阴部感觉麻木
- 异常的球海绵体和眨眼反射
- 括约肌肌力减弱
- 粪便嵌塞
危险因素
- 年龄增长
- 妊娠
- 肥胖
- 盆腔器官脱垂
- 绝经期后
- 使用利尿剂
- 咖啡因摄入
- 便秘
- 大便失禁
- 高强度体力活动
- 阻塞性睡眠呼吸暂停
- 居住在长期护理机构
- 痴呆
- 卒中和其他中枢神经系统/脊柱疾病
- 帕金森病
- 多发性硬化
- 白人女性
- 功能障碍
- 尿失禁家族史
- 小儿遗尿
- 慢性咳嗽
- 糖尿病
- 抑郁症
- 慢性心力衰竭
- 吸烟
- 泌尿生殖系和盆底手术
- 放射暴露
- 饮酒
- 使用抗组胺药
- 镇静剂的使用
- 使用安眠药
- 使用麻醉止痛药
- 使用抗胆碱能药物
- 使用抗抑郁药
- 使用抗精神病类药物
- 使用 α 受体阻滞剂
- 使用钙通道阻滞药
诊断性检查
首要检查
- 咳嗽应力试验
- 尿液分析
- 排泌后残余尿量测定
- 卧位压力试验
需考虑的检查
- 尿动力学检查
- 尿垫试验
- 棉签试验
- 经会阴超声
- 膀胱镜
治疗流程
压力性尿失禁
急迫性尿失禁
混合型尿失禁
撰稿人
作者
G. Willy Davila, MD
Medical Director
Women and Children’s Services
Urogynecology and Pelvic Reconstructive Surgery
Holy Cross Medical Group
Fort Lauderdale
Florida
FL
利益声明
GWD is a consultant/advisory board member for Boston Scientific and Laborie/Cogentix, and a speaker for Laborie/Cogentix, Astellas, Alma, and Ferring. GWD has received research grants from POP Medical, Pfizer, Cook Biomedical, Alma, and Coloplast.
Laura Martin, DO
Assistant Professor
Female Pelvic Medicine and Reconstructive Surgery
Department of Urology
University of Miami Miller School of Medicine
University of Miami Health System
Miami
FL
利益声明
LM is a consultant for Coloplast educational pelvic floor cadaver labs.
鸣谢
Dr G. Willy Davila and Dr Laura Martin would like to gratefully acknowledge Dr Alexandriah N. Alas, Dr Aimee Lynn Smith, Dr Marjorie Jean-Michel, and Dr Peter A. Castillo, the previous contributors to this topic.
利益声明
ANA, ALS, MJM, and PAC declare that they have no competing interests.
同行评议者
Roger R. Dmochowski, MD, MMHC
Professor of Urology and Surgery
Department of Urology
Vanderbilt University Medical Center
Nashville
TN
利益声明
RRD declares that he has no competing interests.
Heidi Brown, MD, MAS
Assistant Professor
Female Pelvic Medicine and Reconstructive Surgery
Departments of Obstetrics and Gynecology & Urology
University of Wisconsin School of Medicine and Public Health
Madison
WI
利益声明
HB receives royalties for authorship from Wolters-Kluwer, Inc. and Springer, Inc. HB provides expert consultations for Grand Rounds, Inc. HB has research funding from the National Institutes of Health, serves on the Editorial Board of Female Pelvic Medicine and Reconstructive Surgery, and is on the Board of Directors for the American Urogynecologic Society (AUGS) and the Pelvic Floor Disorders Research Foundation.
Mohamed Y. Hammadeh, MSc (Urol), FEBU, FRCS (Eng. Urol), Diploma ME (UCL)
Consultant Urological Surgeon
Foundation Training Programme Director
South London Healthcare NHS Trust
Queen Elizabeth Hospital
London
UK
利益声明
MYH declares that he has no competing interests.
鉴别诊断
- 泌尿生殖瘘（尿道阴道瘘、输尿管阴道瘘、子宫阴道瘘和膀胱阴道瘘）
- 异位输尿管
- 泌尿道感染
更多 鉴别诊断指南
- 非神经源性女性 LUTS
- 女性下尿路症状临床指南（第二版）
更多 指南患者教育信息
女性压力性尿失禁
压力性尿失禁：如何进行盆底肌训练
更多 患者教育信息
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