脊髓损伤后尿道内括约肌对排尿功能的影响

For patients with spinal cord injury and rehabilitation doctor, treatment of lower urinary tract dysfunction is a very difficult and has to face the problem. Urinary outlet plays a vital role in micturition function. So far, little is known about the impact of the internal urethral sphincter on urinary function after spinal cord injury, EMG data is lack. Literature and our results confirm that only 30-40% of patients can achieve independent or abdominal urination without the need for catheterization after urethral sphincter relaxation. Our hypothesis is that there may be the internal urethral sphincter dysfunction similar to the external urethral sphincter in patients with spinal cord injury, which affects the urinary function. To test this hypothesis we will implement the animal spinal cord injury model experiment and human experiment. Internal urethral sphincter EMG and urodynamic local pressure change is detected by ultrasound-guided positioning of the bladder neck. We will find out the functional of internal urethral sphincter status and the relationship between of internal urethral sphincter and external urethral sphincter. This study will propose supplementary mechanism of voiding dysfunction in patients with spinal cord injury from the new viewpoint that is internal urethral sphincter dysfunction and provide ideas for improving the treatment regimen.

对于患者和康复医生而言，脊髓损伤后下尿路功能障碍的治疗是一个非常棘手而又不得不面对的问题，尿路出口（尿道内括约肌、外括约肌及尿道）对排尿功能起着至关重要的作用。迄今为止人们对脊髓损伤后尿道内括约肌对排尿功能的影响知之甚少，肌电图研究的资料也是缺失的。文献与我们的结果证实只有30-40%的患者在尿道外括约肌的张力降低后能达到自主或腹压排尿而不需再导尿。我们的假说是：脊髓损伤后患者尿道内括约肌也可能存在着类似尿道外括约肌的功能障碍,从而影响了排尿功能。为了验证这一假说，我们将从动物脊髓损伤造模后实验和人体试验，通过超声引导定位膀胱颈部，检测尿道内括约肌电图和局部的尿动力学测压力变化，明确脊髓损伤后尿道内括约肌的功能状况及其与尿道外括约肌功能的关系。本研究将从尿道内括约肌影响排尿功能这个新视点完善脊髓损伤后排尿功能障碍的机理，为治疗方案的改进提供思路。