CN1867294A - Methods and apparatus for urodynamic analysis - Google Patents

Abstract

Bladder function monitoring methods, apparatuses, media and signals are disclosed. A method includes receiving signals from an electromagnetic radiation detector, the signals representing electromagnetic radiation detected from the bladder during irradiance of the bladder with electromagnetic radiation, and further includes storing data indicative of bladder function, in response to the signals. The received signals may represent near infrared (NIR) detected from the bladder during NIR irradiance of the bladder.

Description

The method and apparatus that is used for urodynamic analysis

Background of invention

1. invention field

The present invention relates near infrared spectroscopy (NIRS) field and in the urology Application for Field, more particularly, the present invention relates to the bladder urodynamics and with the diagnosis of the unusual associated conditions of excretory function.

2. description of related art

The excretory function anomalous effects and is surpassed 50% population.Being used to understand bladder and being main tool how to bring into play function is the urodynamics of test bladder.Urodynamics can be measured bladder capacity, and when full, whether bladder has normal threshold of feeling, and when patient/individuality was drained, whether bladder shrank with suitable intensity.Urodynamic test can inform also whether we patient has obstruction of bladder or leakage of urine phenomenon (incontinence-involuntary leakage) is not arranged, and is pointing out it is the leakage of which kind of type then.Urodynamics can be diagnosed the multiple potential problems of bladder really.It also is used for success or the failure of enforcement to confirm this strategy of therapeutic strategy subsequently.Conventional urodynamic test is made up of-non-invasive urine stream (it provides the information about the bladder emptying), cystometrogram (information when it provides about filling of bladder) and pressure current research (it provides the additional information about the bladder emptying) three components.

For the urodynamics of implementation criteria, require patient's bladder when being tried to be full of.Require this patient to drain on scale, how soon the drainage rate that this scale can provide the patient has and drains total amount.Then, with two catheter positioning, one intravesical and one at internal rectum.Before this point, this experiment is invaded in essence.In addition, the existence of described conduit in urethra is known confounding factor, and this is because described conduit self can cause and blocks excretory, and it can stimulate bladder to cause wrong contraction, and/or has and comprise side effect hemorrhage and that infect.

The urologist is usefully directly measured the idiomuscular contraction intensity of bladder.In order to accomplish this point, conduit can be put into internal rectum, and it is connected with the pressure transducer of measuring abdominal pressure.Second conduit put into the bladder center by urethra, also it is connected with pressure transducer.The pressure that is well known that the bladder center is that abdominal pressure adds the pressure that bladder muscle self produces.Therefore, can calculate the pressure that produces by bladder muscle indirectly.But conventional urodynamic test does not provide the direct measurement to bladder muscle activities.When not using conduit that urine stream is measured, this defective is conspicuous.Excretory urine amount on the scale provides to drain about the urine amount spike how soon.This is called " non-invasive urine stream ".But, use urine stream to test the information that can not write down from bladder muscle.There is the highly compressed bladder that blocks to produce sialorrhea type (dribbling) urine line on unable bladder muscle and the bladder muscle wall with reduction flow velocity.

Summary of the invention

The invention provides bladder function or the urodynamic non-intruding method measured.Non-intruding technology disclosed by the invention can with traditional intrusion pull together to implement with non-invasive urodynamic test.

According to an aspect of the present invention, provide in having the animal of bladder the method for monitoring bladder function, wherein this method comprises optical transmitting set and photodetector is positioned at contiguous animal's bladder place; Detect light with described optical transmitting set at described bladder emission light and with described photodetector; And be collected in bladder and detect the representative data of light when movable, thereby provide the indication of bladder function.Wherein with light emission and detect a period of time, therefore described data represented bladder function in the section at this moment.Also can be positioned on the animal skin of contiguous described animal's bladder.Described light can be near infrared (NIR), and described emitter can be near infrared spectrum (NIRS) emitter, and described detector can be that NIRS detector and described data can be the NIRS data.Described light can be coherent light (coherentlight).

According to a further aspect of the invention, provide in having the animal of bladder the method for monitoring bladder function, wherein this method comprises near infrared spectrum (NIRS) emitter and NIRS detector is positioned at contiguous animal's bladder place; Use detects NIR light with the NIRS detector simultaneously at the NIRS at animal's bladder place emitter emission near-infrared (NIR) light; And be collected in bladder detect when movable the representative NIR data of NIR light, thereby the indication of bladder function is provided.Can be positioned on the animal skin that is adjacent to described animal's bladder.Described near-infrared (NIR) light can be coherent light.

Described method can comprise localization by ultrasonic or selectively locate by 10mm the side that NIRS emitter and NIRS detector is placed on described animal pubic symphysis that especially, wherein said animal is the adult.

Ultrasonic locating can comprise that the ultrasonic energy of autobiography sensor transmits in the future; And thereby the ultrasonic energy that receives reflection is determined the step of animal's bladder position.

Described method can comprise the NIR light of emission in 750-950 nanometer (nm) scope greatly.

Described NIR light also can be limited to 760-920nm.Selectively, this NIR light can be between 770-910nm or 780-900nm or 790-890nm.

For example, thus collected NIRS data can be handled HbO2 Oxyhemoglobin (HbO is provided ₂); Deoxyhemoglobin (Hb); Cytochrome a, the a3 of oxidation; Reductive cytochrome a, a3; The oxidation of cytochrome C oxidase subtracts one or more information that change in the indication of described animal level in reduction form oxidized minus reduced forms (Cyt) or other chromophore.

Described method also can comprise the location, and it comprises uses described NIRS emitter of light barrier protection and NIRS detector, thereby surround lighting is foreclosed, in order to avoid disturb the collection of NIRS data.

Described method also can be included in the NIR light that decay is launched before the animal's bladder place emission NIR light, and described thus attenuation is usually used in remedying the variation in the physical parameter of described animal.Attenuation can be finished by filtering the NIR light of being launched.In addition, the available filter tank of the filtration of described NIR light realizes that described filter tank has the light filter of selectable variable density, and it operationally increases the NIR light of light filter emission.

Described method also can be included in when collecting the NIRS data or not obtain the ultrasonic measurement of described animal's bladder parameters simultaneously.

Described method also can comprise the location of described NIRS emitter and described NIRS detector, makes this NIRS emitter and this NIRS detector 15-90mm at interval.

According to a further aspect of the invention, light shield apparatus is provided, it comprises lighttight shield, it has emitter aperture, detector aperture and ultrasound probe aperture, wherein said emitter aperture, detection hole and ultrasound probe aperture allow near the definite zone on the animal skin, and described light shield apparatus is applied to this zone; Emitter retainer, it operationally remains on the NIRS emitter in the described emitter aperture, make the position of described NIRS emitter near the emitting surface on the animal skin, wherein this emitter retainer operationally reduces the interference of surround lighting to animal skin surfaces by this emitter aperture; And detector retainer, it operationally remains on the NIRS detector in the described detector aperture and with described NIRS emitter has at interval, make the position of described NIRS detector near the searching surface on the animal skin, wherein this detector retainer operationally reduces surround lighting by the interference of this detector aperture to animal skin surfaces.Described equipment also can comprise the ultrasound probe closure (ultrasound probe closure) that has out and close the position, the closed operability of described ultrasonic wave hole ground allow ultrasonic detector in the position of opening by described light shield apparatus near animal skin, and when the position of closing, it operationally reduces the pollution of surround lighting to animal skin surfaces by described ultrasound probe aperture.Described light shield apparatus also can comprise attachment system, and it operationally remains on described light shield away from described zoodermic position.For example, described attachment system can be selected from diaper, adjustable belt, adjustable belt system, viscosity glue, adhesive tape, electrostatic charge, vacuum suction and stressed Mk system.Described equipment also can comprise adapter lead and keep system.

Described light shield apparatus also can be defined size, makes described emitter aperture away from described detector aperture, thereby makes described NIRS emitter and described NIRS detector separate about 15-90mm.Selectively, described interval can be between 25-80mm or 35-70mm or 45-60mm.

According to a further aspect of the invention, in order to use method of the present invention, the filter plant of the NIR light that providing is used to decay is launched.This filter plant can comprise the filter tank, described filter tank comprises the light filter and the selective system of a plurality of variable densities, the NIR light that described variable density filter operationally increases launching from described total unfiltered output illumination filters, and one or more described a plurality of variable density filters can be located on the light path of the NIR light of being launched thus.

Described filter plant also can comprise a series of slidably light filter, it has strain position and non-strain position, and selective system wherein comprises actuating device, and described actuating device operationally optionally slides into described strain position or described non-strain position with one or more described a plurality of variable density filters.

Described a plurality of variable density filter can be come stepping with increment, described increment is selected from 1%, 2%, and 3%, 4%, 5%, 6%, 7%, 8%, 9% and 10% total unfiltered output is thrown light on.Selectively, described a plurality of variable density filters can be come stepping with 5% or 6% or 7% increment of total unfiltered output illumination.

According to the explanation and the accompanying drawing of following particular of the present invention, the one of ordinary skill in the art can understand others of the present invention and feature apparently.

Brief Description Of Drawings

In the accompanying drawing of explanation embodiment of the present invention,

Figure 1A is depicted as the flat sheet of the bottom view of described light shield apparatus embodiment.

Figure 1B is depicted as the top plan view of the embodiment shown in Figure 1A.

Fig. 1 C is depicted as the cross sectional side view that the embodiment shown in Figure 1B is cut open along the c line.

Fig. 2 A is depicted as the front view of described filter plant embodiment.

Fig. 2 B is depicted as the top plan view of the embodiment shown in Fig. 2 A.

Fig. 2 C is depicted as the cross sectional side view that the embodiment shown in Fig. 2 B is cut open along the c line.

Fig. 3 A is depicted as No. 21 urodynamics spikes that the patient urinates stream, it shows being lower than the detrusor over activity in normal range and draining pressure of 82 years old elderly men patient, this patient suffers from angina pectoris and type ii diabetes history, and suffers from frequent micturition, x3 nocturia and prostate hyperplasia (BPH).

Fig. 3 B is depicted as No. 25 urodynamics spikes that the patient urinates stream, and it shows 62 years old old women patient's normal urine stream, detrusor over activity, urgency incontinence and normal baric flow, and this patient suffers from the frequent and urgency incontinence history of urgent micturition.

Fig. 4 A is depicted as No. 26 urodynamics spikes that the patient urinates stream, and it shows 67 years old old women patient's normal urine stream and detrusor over activity, and this patient suffers from frequent micturition, urgent micturition and incontinence history.

Fig. 4 B is depicted as No. 27 urodynamics spikes that the patient urinates stream, and it shows 72 years old elderly men patient's neural prototype bladder disorders, and this patient suffers from the spinal cord injury history.

Fig. 5 A is depicted as No. 28 urodynamics spikes that the patient urinates stream, and it shows the prolongation of 34 years old female patient but almost urinate stream normally that this patient suffers from frequent micturition, interstitial cystitis, and does not have the incontinence history.

Fig. 5 B is depicted as No. 30 urodynamics spikes that the patient urinates stream, and it shows the urine that slowly the begins stream of 30 years old female patient, and this patient suffers from urgent micturition, frequent micturition and some incontinence histories.

The urodynamics spike of CMG when Fig. 6 A is depicted as No. 21 patients and lies on the back, it shows that 82 years old elderly men patient has low systolic pressure and low flow velocity because block, this patient suffers from angina pectoris and type ii diabetes history, and suffers from frequent micturition, nocturia x3 and prostate hyperplasia (BPH).

The urodynamics spike of CMG when Fig. 6 B is depicted as No. 22 patients and lies on the back, it shows 65 years old elderly men patient's high systolic pressure and low flow velocity, this patient suffers from blocks and urgency incontinence.

The urodynamics spike of CMG when Fig. 7 A is depicted as No. 23 patients and lies on the back, it shows 55 years old elderly men patient's detrusor over activity, urgency incontinence, high systolic pressure and blocks, this patient suffers from sialorrhea behind the flow velocity, frequent micturition, drainage of minimizing.

The urodynamics spike of CMG when Fig. 7 B is depicted as No. 24 patients and lies on the back, it shows 65 years old male patient's unwilled detrusor contractions, this patient suffers from unwilled detrusor contractions and overflow urinary incontinence.

The urodynamics spike of CMG when Fig. 8 A is depicted as No. 25 patients and lies on the back, it shows 62 years old old women patient's normal urine stream, detrusor over activity, urgency incontinence and normal Arius, this patient suffers from the frequent and urgency incontinence history of urgent micturition.

The urodynamics spike of CMG when Fig. 8 B is depicted as No. 26 patients and lies on the back, it shows 67 years old old women patient's normal urine stream and detrusor over activity, this patient suffers from frequent micturition, urgent micturition and incontinence history, but does not have stress incontinence.

The urodynamics spike of CMG when Fig. 9 A is depicted as No. 21 patient in sitting, it shows 82 years old bad flesh compliance of elderly men patient, this patient suffers from angina pectoris and type ii diabetes history, suffers from frequent micturition, x3 nocturia and prostate hyperplasia (BPH).

The urodynamics spike of CMG when Fig. 9 B is depicted as No. 23 patient in sitting, it shows 55 years old elderly men patient's detrusor over activity, urgency incontinence, high systolic pressure and blocks that this patient suffers from the flow velocity of minimizing.Frequent micturition and drainage back sialorrhea.

The urodynamics spike of CMG when Figure 10 A is depicted as No. 24 patient in sitting, it shows 65 years old male patient's unwilled detrusor contractions, this patient suffers from unwilled detrusor contractions and overflow urinary incontinence.

The urodynamics spike of CMG when Figure 10 B is depicted as No. 25 patient in sitting, it shows 62 years old old women patient's normal urine stream, detrusor over activity, urgency incontinence and normal baric flow, this patient has the frequent and urgency incontinence history of urgent micturition.

Figure 11 A is depicted as the urodynamics spike of 1 st volunteer urine stream, and experiment for the first time shows 50 years old normal bladder function of old women volunteer, this patient body health, no urology disease.

Figure 11 B is depicted as the urodynamics spike of 1 st volunteer urine stream, and experiment for the second time shows 50 years old normal bladder function of old women volunteer, this patient body health, no urology disease.

Describe in detail

Common methods and equipment

(1) urodynamics

Use Laborie and drain function test instrument enforcement urodynamic analysis. Urodynamics is by 3 Asias One-tenth is grouped into. This standard scheme is used for all patients described below.

A. urine flows

Its bladder was full state when described patient arrived the laboratory. The male patient is stance and woman The property patient when being sitting posture, implement the experiment of non-invasive urine stream. This patient spontaneously, as much as possible row Empty bladder. Then conduit is inserted in the bladder, remaining urine is drained and measure its volume.

B. filling phase cystometrogram (CMG)

With the urodynamics conduit of 8Fr twice lumen, urodynamic balloon rectal catheter and EMG perineum lead is placed with standard mode. This patient lies on the back. Water with aseptic room temperature With with the speed of the bladder state consistency of individuality, with the perfusion of Laborie pump. Require the patient to point out " the One sensation ", the sensation of " urgent urination " and " ability ", the definition of these terms and international self-control association The definition of (International Continence Society) is consistent.

" first sensation " or " wanting to drain for the first time " are defined as normal drainage needs, and are retouched State the sensation for described individuality is drained again next time when being fit to, but if necessary Can postpone to drain. Strong drainage desire is defined as the drainage desire that continues in the time of can not fearing seepage. Otherwise " urgent urination " is defined as the strong needs of wanting to drain, and is accompanied by seepage fear or pain Frightened. Term " ability " must quantification. In having the patient of normal threshold of feeling, maximum bladder The internal pressure measurement ability is the volume of described individuality when feeling that it can not postpone to drain again. Work as impercipience Shi Buneng is with the maximum cystometric capacity of identical term definition, and its volume is by clinical The doctor determines the volume that stops filling. Not full-time at sphincter competence, maximum intravesical pressure is measured energy Power can by the obturation of urethra, for example increase by the Foley catheter significantly. " functional bladder Ability " or the volume of draining be more relevant, and can be undertaken by frequency/volume diagram (uropoiesis daily record) Estimate. " maximum (anesthesia) bladder capacity " is in degree of depth whole body or backbone/caudal anaesthesia, regulation Under the temperature of fluid, filling pressure and the TPER condition, the full rear volume of measuring.

When measurement capability, described bladder is drained through catheter by syringe, and uses electronic urine Dynamic experiment table/chair converts described patient to sitting posture. With identical infusion rate duplication of bladder Full, again record the indication of bladder sensation, but when heap(ed) capacity, require this patient spontaneous Drain. (this is the beginning of the pressure current section of this research. ) not all laboratory is with two kinds of positions (lie on the back and stand) implementation this cystometrogram filling phase. But such way has Integrality, because as everyone knows when filling of bladder, patient body position's variation can expose some pathology Problem.

C. pressure current

There is the patient of catheter, rectal balloon and EMG lead to be required spontaneous in position Ground is drained in flowmeter. This has produced the pressure current spike. When drawing pressure current research figure, should With the Abrams-Griffiths nomogram to indicate obstructed flow district and non-obstructed flow district. Urine in standard is moving In the mechanics spike,, detrusor pressure (pdet) value is the baroreflex that is caused by bladder muscle in the bladder, And can calculate by from bladder pressure (pves), deducting abdominal pressure (pabd). Pves is at wing The pressure of measuring with conduit in the Guang, this conduit is specifically designed to monitor the pressure in the urethra. The institute The pressure information that obtains is to be applied to Supravesical pressure by abdominal contents, any urine in the bladder The weight of liquid or pressure and detrusor are applied to the combination of the power on the urine. Static pressure is commonly referred to as Empty intravesical pressure, and can change with position. Normal bladder static pressure can be at 8-40cmH₂Change between the O, this depends on special patient and position in the research process. Pabd is by with the spy Different conduit be placed in the rectum or vagina in measure. Abdominal pressure information is important, this be because of For bladder is included in the bottom in abdominal cavity, and the pressure that will in bladder, take place and activity be separated into close heavy Want. Described detrusor pressure is by deduct the phase that described pabd calculates from described pves Decompression power. The pressure current spike is shown as waveform, and this is illustrated in and takes place in bladder in the CMG process Authentic activity. The weight of the strain of belly, gas and abdominal contents can produce illusion, this vacation Resembling can be by removing from the information from the processing of catheter in the bladder.

(2) near infrared spectroscopy (NIRS)

A. the NIRS urodynamic methods of commonly using

NIRS equipment be from shore pine photonic propulsion KK (325-6 Sunayama-Cho, the Bin Song city, 430-8587 Japan) commerce obtains. This method is what to use from shore pine photonic propulsion equipment company NIRO-300^TMNear infrared spectrometer is finished. This NIRO-300^TMHas the urine of being fit to power The data collection intervals of Epidemiological Analysis and can measure cytochrome c oxidase, it is being secreted for NIRS Urine is learned the important component in using. For example, the transmitter that is used for NIRS can be selected from filtered white light, Direct band gap (direct-gap) gallium aluminum arsenide (GaAlAs) semiconductor kistributed-feedback laser, and/or light emitting diode is (namely IRED). Described white light source can be xenon lamp or Halogen lamp LED, and its filter component is usually by at each sheet The rotating circular disk that all comprises the segmentation of particular filter wavelength in the section forms. The advantage of described white light source exists In a large amount of wavelength can be provided. The infrared emitting scope of GaAlAs laser instrument is specific, and can Unique that wavelength-described laser instrument is made by impulse action is many thereby provide by the width of regulating the slit Plant wavelength by continuously synchronization. The advantage of laser instrument is that it has sufficient power stage with complete Become significant tissue depth to penetrate. IRED ' s be by the positive that directly contacts with each other with half of feminine gender Conductor material and the interface of selecting in order to obtain specific wavelength form. IRED ' s has The input power requirement is low, efficient is high but heat generation is little and the advantage of long service life. At needs not With emission the time, can produce multiple infrared emission with single light source, perhaps can use a series of The laser instrument of separation produce multiple infrared emission. Used " light " of the present invention refers to electromagnetism Radiation. The used coherence who relates to " light " (being coherent light) is the characteristic of laser, and it comes from and is subjected to Excite the process of penetrating so that amplification to be provided. The common stimulus triggers emission, it provides and has caused launching photon Amplification light, described photon is " synchronous " and have each other definite phase relationship. In this theory Term with temporal coherence and spatial coherence in the bright book is described the coherence.

Described NIRO-300^TMNear infrared spectrometer is transmitted in the 760-920 nanometer range continuously The gate nanosecond pulse of near infrared light photons interior, four kinds of wavelength. When the photon of launching by oxygen Close hemoglobin (HbO₂) and the change in concentration of deoxyhemoglobin (Hb), and subtract reduction by oxidation The shape cytochrome C oxidase, be also referred to as mitochondrial cytochrome a, the copper part of a3 (Cyt) clean When the change of divergence absorbed, it can detect the loss of luminous intensity. In addition, NIRS also can detect oxygenate Myoglobins (MbO₂); And deoxidation myoglobins (Mb). But, in the 760-920nm scope, Mb and MbO₂Spectrum can not with Hb and HbO₂Difference is come. Described hemoglobin data is carried Supplied about the insight of oxygen to organized delivery, described cytochromes data then illustrate described tissue Whether utilized the oxygen that transmits. In described urology design conditions, main designing requirement Be with than 1 second interval faster speed collect and report data. This is essential, because at bladder Be full of with discharge process in quick variation can take place.

The NIRS auroral poles that is made up of NIRS transmitter and NIRS detector can be placed in wing by outer land used On the Guang. The placement of NIRS auroral poles can make described NIRS transmitter vow along any coronal-plane, arrow Face, transverse plane or diagonal plane or back or front, the left side or the right side, afterbody or head or phase To any plane at random near the NIRS detector. The placement of NIRS auroral poles selectively makes described The NIRS transmitter is at the reverse side of described NIRS detector. For example, can be placed on an auroral poles described Also putting behind another in the front of animal, perhaps an auroral poles can be able to be placed on the left side and with another The individual right side that is placed on. Usually, the orientation of transmitter and detector can be (from left to right) of level, and is vertical (afterbody is to head) or arbitrarily, this depends on the monitored described animal/patient's of wish dissection Learn structure and age. The location of auroral poles requires the bladder near described individuality usually. Under this area The technical staff is to be understood that this equipment and this method can be applicable to any animal that bladder is arranged.

Consider the head of the about 10mm that for example usually places it in adult's midline pubic symphysis Side, placement and the orientation of NIRS auroral poles (NIRS transmitter and NIRS detector) can be with respect to bladders Physical location determine perhaps supersonic sounding or other detection well known in the art by bladder Method is determined.

The interval of NIRS transmitter and NIRS detector (wherein said arrangement is " vicinity ") is logical Often be to be about 15-90mm from center to center. Selectively, described interval can be 25-80mm Or between 35-70mm or 40-60mm or the 35-55mm. But, can be according to used laser Power is adjusted the interval. For example, if use 1mW laser power, then about interval 35-55mm The time just can collect reliable NIRS data. Usually, if laser power increases, then need bigger The interval, this is because the degree of depth that penetrates is darker, and subsequently by the photon of refraction return wider The basis. But the laser power of increase may be dangerous to organizing. Similarly, littler laser Power produces narrower interval, but penetration depth is more shallow. But, if laser power is too low, Then described light can't penetrate fully skin thickness and detect bladder.

Pulse duration and frequency are technical limitations, thereby NIRS requires the light of a plurality of wavelength to solve multiple chromophoric problem (being the X equation of X the unknown) on mathematics.Though laser instrument can be used for launching discrete wavelength, photon detector can detect but all no matter what light wavelength be.Therefore, NIRS engineering uses pulsed lasers, the pulse that make to arrive described detector can be by timing, thereby is associated (a kind of laser of every wavelength is just as a kind of laser of every chromophore) with pulse sequence from multiple laser instrument.The pulse duration of described laser instrument and pulse frequency (as combination) must have fully " passs " thus the stage make and do not have crossover between the emission, have equally also that " opening " stage is passed the described detector of arrival to allow described photon fully.When number of lasers increases, the bigger danger of mistaking is arranged then.Fortunately, the light velocity is in fact very fast, and pulse duration/frequency is coupling easily normally, even make and to use many laser instrument, rather than described NIRO-300 ^TMOnly 4 laser instrument of Shi Yonging also seldom have the danger of crossover.Usually, seldom need to change pulse duration or frequency.The resolution of monitoring increases with the increase of number of lasers usually.Except have 3 be used for 3 chromophories (be Hb, HbO ₂And Cyt) outside the laser instrument, described NIRO-300 ^TMUse 4 laser instrument, unnecessary one provides better resolution.

As long as have sunlight and artificial light, described NIRS illumination detector just can not be distinguished incident NIRS emission light and bias light on every side, therefore must shield the emission of described patient skin and detect the surface to block ambient light.

As mentioned above, available ultrasonic location of finishing described light shield, NIRS emitter and NIRS detector is used the bladder of ultrasonic detector locating individuals thus.In addition, but the using ultrasound ripple provides the indication of intravesical urine capacity.Ultrasound volume readings before and after urinating can be used to measure described intravesical may not excretory residual urine volume.Ultrasonic is preferred measuring method, and this is because it can be at skin surface non-invasively, rather than inserts by conduit and to measure.

In case behind the location, described light shield can be fixed with the adhesive tape of viscosity.Selectable attachment arrangement is selected from diaper, adjustable belt, adjustable belt system, viscosity glue, electrostatic charge, vacuum draw and stressed Mk system or other system well known in the art.Selected attachment arrangement may depend on desire and collect the persistent period of data and the type of data collection (being the monitoring of clinical operating position or family).

For family's monitoring or the long term monitoring in nursing unit, described NIRS equipment can be made into portable, thereby makes the full and drainage that individuality can be dressed this equipment chronically or carry this equipment monitoring bladder.Described auroral poles and light shield can keep in position with belt, and described laser instrument, power supply, control assembly and data recording equipment are contained in the knapsack.

Before urine stream, begin to collect the NIRS data, and described collection is run through full-fledged research to each patient.Before the beginning of urine stream, it is important beginning to collect described NIRS data.Present urodynamic methods, that only usually allows to hit described scale from urine constantly begins to collect data.For described NIRS, can write down data about bladder contraction, bladder contraction took place before draining.In described CMG process, with event marker be placed on simultaneously show in described NIRS and the Laborie data flow begin to inject, any variation of bladder sensation, bladder capacity and described patient body position.

NIRS monitoring is accepted in requirement in urodynamics out-patient department patient is when family arrives, and its bladder suitably is full of, and in described observation process, the patient is the emptying bladder subsequently.Selectively, can be with catheter through per urethram entering bladder, and when NIRS monitors the filling of described bladder, pour into Sterile Saline with it.The program that is used for the NIRS monitoring at first lies low at simple and easy lectulum from described patient usually, and the portable ultraphonic effusion meter is placed on its abdominal part to identify the position of bladder simultaneously.The NIRS viscosity light shield and the detection detector of described merging illumination are sticked to by on the skin surface in the zone of described ultrasonic device identification.Pass through process repeatedly then, calibrate described NIRS device solving background field intensity, skin color and tissue density, this process repeatedly can require to add the optical attenuator neutral density filter with the characteristic physical parameter that solves described patient (being body weight, cutaneous pigmentation, skin thickness, bladder size, detrusor thickness, former operation on pelvis, obesity, suprapubic fat pad, tissue water content).After the calibration, described patient lay several minutes flat, was enough to determine to have obtained the preceding baseline monitoring level of stable drainage.Behind the given stable baseline, NIRS continues monitoring at interval with 1-10Hz, and simultaneously described patient's emptying bladder is called the collecting chamber of uroflometer to the urologist, and it can be designed to described simple and easy lectulum or uroflometer independently.

Can with described collecting chamber digitized receive the non-NIRS system that estimate to discharge flow velocity and momentary voided volume.Usually standing or be seated by the male and the women is being seated and finishes from these parameters of described uroflometer.Selectively, described NIRS oxidation monitoring and non-NIRS urine discharges/capacity are monitored and can be sitting in portable chamber pot by the patient and finish.When draining beginning, described patient declaims him and is just beginning to urinate, and connects described NIRS device by trigger moment, with this event flag in described NIRS data flow.In case this patient feels its bladder emptying, he roars and this incident similarly is marked in the described NIRS data flow.After second time incident, NIRS continues monitoring several minutes, is enough to determine to have set up baseline values after the stable drainage.Selectively, need record when primary response, the remote control trigger device of event markers can allow described patient to switch described event markers on the described NIRS equipment.The patient oneself trigger of described event markers is important in the urinary system inspection, and this is because described patient's consciousness is the key component of incontinence

If between filling period, need to monitor described diagnosis, then can under nothing notes the situation of NIRS monitoring, the urodynamics injection/pressure catheter of standard be installed in a usual manner.The above-mentioned same NIRS steps as of the bladder that is used to be full of also is applicable to by the full empty bladder of described catheter.Some urology inspection may require the full continuously and emptying via described catheter, and these can be implemented in described identical NIRS mode.After monitoring is finished, described NIRS light shield is removed on one's body from described patient, and collected data are sent to the software kit that is used for post analysis, display format and subjective interpretation.

(3) light shield apparatus

For urology inspection of the present invention, present NIRS ambient light shield is intended to be placed on described patient's forehead, is not suitable for being positioned on the bladder very much.The urologist uses ultrasonography to assess bladder wall thickness, cross-sectional area and retention volume, but it is difficult to combine application with NIRS, and this is will to stop up from the ultrasound wave near skin surface because can be used for the light shield of conventional NIRS application at present.Carry out if described ultrasound procedure is used prior to described NIRS shielding, then the residue of described ultrasound barrier gel can make the viscosity in the described NIRS shielding die down.The shielding that dies down can be peeled off from described patient under the gravity of described NIRS connection cable subsequently on one's body, causes the leakage of surround lighting, has destroyed described NIRS calibration, makes that described data collection is weakened.And, handle described NIRS barricade, be suitable trouble so that described emitter and detector together with as appendicular two sides adhesive tape, are installed on described patient's the skin, and delayed the time stream of patient in described urinary system clinical diagnosis.The invention provides the NIRS light shield, it makes and carries out NIRS and ultrasonography simultaneously and become easily, and has reduced the probability of ambient light leakage.But,, also can use the light shield that is not used in ultrasound structure not needing to use under the situation of ultrasonic detector.Do not using under the ultransonic situation, can use urethral catheter and measure described surplus urine.

Usually, the NIRS ambient light shield designs according to following principle: thus promptly described shielding must enough pliable and toughly meet crooked, hard skull surface, therefore requires binding agent can guarantee fitness and edge sealing, and prevents slippage.And described barricade is intended to be used for baby and unconscious patients, and they may be unrestful in secular brain observations process, and when using the bad light shield of the suitability, their uneasy trend may cause the mobile illusion in the described data flow.But, in the NIRS urology applications, (except that the family's monitoring) that the sampling time is normally brief, if be softish abdominal part structure, then fitness and slippage are not problems, can design excessive shielding and surround abdominal part, the feasible sealing that need not to pay close attention to the edge.Described patient can pass through hand, passes through to dress the described shielding of merging diaper, by the weight band described shielding be kept in position, or retrains described shielding by wearing " fine hair and sticking ditch " adjustable band.The delay that therefore such selection can be eliminated needs and be caused by the application binding agent.

Preferred NIRS light shield apparatus can be made of opaque shield, described shield is made by disposable foam curtain, and wherein said shield has and is used for hyperacoustic hole and holder (emitter and detector) or is used to equip the fixation clamp of described NIR emitter and NIR monitor terminal.

Selectively, thereby described light shield can have the size that 3-d modelling is suitable for special application and is fit to described patient, no matter is the baby, child, juvenile or adult.Yet the light shield that is used for the baby can be designed to cover whole waist, if front and rear all is exposed to surround lighting, if when perhaps described patient lies on the back, covers whole abdominal part.For the adult, the optical screen of spendable minimum barrier is 160mm * 160mm, and larger sized shielding is preferred.The environment light intensity is a greatest factor of determining shield size.In the surgery that can use NIRS was provided with, intensive overhead light made that intending detected Zone Full all is capped, rather than only relies on described light shield itself.In the urology NIRS monitoring that has sunlight or other surround lighting to exist, also need similar strategy.The replacement that aiming screen covers is to monitor in the darkroom.

Described light shield has emitter aperture, thereby the NIR light that allows to be launched emits and enter into described tissue from described Conductive fiber light beam or NIRS emitter.Described light shield also has a detector hole, thereby the photon that allows to be reflected emits and strikes on the surface of conventional photodiode collection array or NIR detector from described tissue.In addition, described light shield also has a ultrasound probe aperture, passes this hole and can place ultrasonic detector, thereby allow shielding on described skin surface can be positioned the middle part of the bladder that detected.Described light shield apparatus can comprise detector fixation clamp or detector retainer, thereby described photodiode array terminal or NIRS detector are fixed or remained on the described light shield.Described light shield can also have emitter fixation clamp or emitter retainer, thereby fixing or keep described fiber optic bundle emission prism or NIRS emitter.Described light shield also can have softish, hinged, fin or other ultrasonic detector closures, with described ultrasonic detector not in the sealing of described ultrasonic hole, thereby reduce ambient light interference.Described light shield can also have the interface cable holding device, and it can adopt and be intended to retrain the reverse saddle type ridged formula that interface cable extends out from described photodiode (NIRS detector) and emission (NIRS emitter) terminal.Those skilled in the art should recognize described light shield and associated component can be by photoresistance arbitrarily disconnected or opaque material make for example wood, rubber, metal forming or contain rubber of cloth or the like.Also should recognize and can adopt by any attachment that described shielding original position is maintained, described device is selected from liquid or machinery, electrostatic charge, ultrasound wave barrier gel, vacuum draw, glue or adhesive tape, belt or stressed Mk system or the like.

In operating process, described light shield apparatus can shift out from the packing of sealing, and the cervical region of described ultrasonic detector can be placed the ultrasound probe aperture of passing described shielding.Thereby described ultrasonic detector can move to location, hypogastric region top subsequently and measure the described bladder of not touching.Above described light shield is positioned at described patient's bladder and when remaining on the position of described skin surface, it is motionless that described ultrasonic detector can keep above described measuring position subsequently.Then, can mobile ultrasonic detector and it is arranged on the next door.After this can light shield be attached to skin surface by multiple attachment arrangement.After light shield was arranged on the appropriate location, NIRS detector and NIRS emitter terminal can be attached to lip-deep holder of they light shields separately or fixation clamp.Then, can close ultrasonic port lid and begin NIRS and analyze, carry out calibration/attenuation and data collection subsequently simultaneously.Any time in the process that NIRS analyzes, light detects and can suspend, and the ultrasound probe aperture of light shield can be opened, and can carry out the measurement of ultrasonic detector under the situation of not interference shielding setting.After data collection is finished, NIRS emitter and detector (and the gravity band under the situation of lying on the back) can be removed from ambient light shield, and described shielding can be removed on one's body and abandoned from the patient then.

Under the situation that has sunlight and artificial light, the photon-counting tube that is generally used for the photodiode of NIRS device or NIRS detector and illumination detector can not distinguish the NIRS emission and by the emission that environmental background light is produced, it is crucial shielding the emission of individual's skin thus and detecting the zone that is applied with light shield apparatus on surface and the individual's skin.

Described light shield apparatus also can be used for the location by intrinsic emitter of opaque light shield and detector aperture, and the NIRS emitter is arranged on apart from NIRS detector a distance.The Center Gap of NIRS emitter and NIRS detector can be 15-90mm usually.Alternatively, described interval can be 25-80mm or 35-70mm or 40-60mm or 35-55mm.Yet,, can adjust described interval according to the size of used laser power.For example, if use the laser instrument of power, then under the interval of 35-55mm, can collect and obtain reliable NIRS data as 1mW.Usually, if laser power increases, then need bigger interval, this is because the degree of depth that penetrates is darker, and the wideer basis of being returned generation subsequently by refractive photon.Similarly, less laser power produces narrower interval, and penetration depth is more shallow simultaneously.But if laser power is too low, then described light can't penetrate skin thickness fully and detect bladder, and if laser power is too high, then may produce harm to tissue.

(4) defecator

Usually the near infrared spectrometer (NIRS) to clinical use carries out optimization, to carry out the brain tissue oxidizing monitoring, and NIRS output illumination has enough power, thereby make photon can pass through complete human skin, brain bone and corticocerebral thickness, and make the photon of refractive near-infrared (NIR) light can reappear in skin surface to detect.When photon bumps against with unpredictable angle of incidence and refrangible surface, can the accidental refraction that NIR light takes place.Therefore, the photon that reappears in skin surface has around the initial very big diffusion area of organizing inlet point.The photon that minority reappears will arrive the position near initial inlet point, and a few photons will arrive the initial point pole position far away of distance; Yet most of photons will arrive the suitable strength zone line between these ultimate values.The NIRS photon detector need be arranged within the zone that reappears photon with suitable strength.By changing the mechanical separation between fiber optic bundle emission terminal (NIRS emitter) and the photodiode detector array terminal (NIRS detector), perhaps can realize this point with the interval of fixing two terminals by weakening emission light.In NIRS calibration phase place, the signal ratio of output and input illumination is estimated, thereby whether the position of determining described detector is best.

If there is big surface area to can be used for that brain NIRS detects, then fixing or variable terminal compartment all can be used for and is applicable to clinical demand.Yet, when the ratio of monitoring bladder size and lighting power, can produce the best zone that reappears in the bladder periphery outside usually, produce narrower NIRS terminal compartment thereby therefore must weaken lighting power.The usual means that is used to decay is to pass through optical neutral density filter before NIRS being transmitted in enter tissue.Required attenuation degree can be according to body weight, cutaneous pigmentation, skin thickness, bladder size and detrusor thickness and along with patient's difference.For described transmutability is provided, need multiple neutral density filter, because NIRS laser illumination power itself is (unless the replacing whole laser instrument series) that is difficult to adjust.

Normally by realizing optical attenuator in the device that a plurality of light filters is penetrated the NIRS fibre bundle.But this is a hard work, because its needs exclusion process repeatedly is to reach correct optical filtering density.For fear of by the delay that combination caused that penetrates, takes out, penetrates again uncertain light filter, the present invention introduces one group of slip filter that is contained in the filter chamber, and described filter chamber is attached to from NIRS laser instrument or NIRS laser instrument sequence leads to NIRS emitter fiber optic cables.

Filter chamber can have four filters, and wherein each filter is made up of opaque carrier.Described carrier can have two perimeter notches, be equipped with spring, during most advanced and sophisticated bump bonds for circular centering rod, described notch can be used as the location to be stopped.Carrier also can have optical neutral density filter and light hole.Can connect at the round nose in the most close hole of carrier and engage catch bar or actuator.The spring that is loaded that bar is returned can be connected with the round nose of close light filter of carrier.In use, can promote engaging lever, slip into the sense of touch and the sound of aligned notches by centering rod and determine to select light filter or light hole against the spring tension that bar is returned.In described chamber, filter carrier plates can be aimed at light guide channels.Described raceway groove can make the photon leakage in the scope that is caused at interval by essential carrier minimize, and described carrier is spaced apart is enough to make user to start single carrier by a finger.Described chamber can directly be connected with the laser illumination interface at an end of chamber; And be threaded with fibre bundle (NIRS emitter) at the other end of chamber.

Each filter can comprise step filter and light hole.For instance, the step filter in 4 filters can bring the increment of the output illumination total amount 6% that equals not filter.First filter has 6% light filter.Second filter has 12% light filter.The 3rd filter has 18% light filter.The 4th filter has 24% light filter.By selecting the combination of light filter and light hole, can realize the 12 steps progressive decay of scope in output illumination total amount 0% to 72%.Alternatively, described 4 plate system can be formed 12 steps decay to realize from 0% to 60% by 5% step filter, and to be made up of with the realization scope 4% step filter be 0% to 48% decay.Alternatively, the system of 3 filters will allow 8 grades decay, attenuation range is to any one of following scope, i.e. 72% in 64% or 9% step filter in 56%, 8% step filter in 48%, 7% step filter in 6% step filter from 0%.

By with the carrier jointer and return push rod replace with by step filter the institute might make up with software algorithm circulate bonded miniature thread worm driving motor and by the time-out (it is based on the selection to acceptable Reduction Level) also can realize automatic decay.Alternatively, described attenuating device can optionally be placed on the rotatable rotating disk to select required filter settings.

As a kind of selection of decay, a plurality of laser instrument can be integrated with the single assembly of the range of physical parameters that is suitable for animal.

Brief description of the drawings

With reference to Figure 1A, wherein show device according to the first embodiment of the present invention by 10 expressions.Figure 1A shows the view towards the light shield apparatus of skin and equipment interface surface interface that will be placed on the patient skin.Opaque body masked segment is by 12 expressions, and described opaque body masked segment 12 is limited with three holes, emitter aperture 14, detector aperture 16 and ultrasound probe aperture 18.These holes make can touch localized area on the main body skin of light shield apparatus to be applied.Figure 1B be towards with the view of the embodiment of the skin interface surface opposite surfaces shown in Figure 1A.This light shield apparatus is still by 10 expressions, and opaque shield is by 12 expressions, and emitter aperture is by 14 expressions, and emitter retainer is by 24 expressions.Detector aperture is by 16 expressions, and detector retainer is by 26 expressions.Different with Figure 1A is that Figure 1B shows the ultrasound probe closure 20 that is arranged in ultrasound probe aperture 18 (not shown).Figure 1B also shows the interface cable channels by 22 expressions.

With reference to Fig. 1 C, the side sectional view that passes Figure 1B equipment that it obtains for the hatching c in Figure 1B.In cutaway view, opaque shield is by 12 expressions, and the emitter aperture that is limited by opaque shield is by 14 expressions, and emitter retainer is by 24 expressions.Similarly, represent by 16 that by the detector aperture that opaque shield limits detector retainer is by 26 expressions.Also show ultrasound probe closure 20 in this cutaway view, it is installed in the ultrasound probe aperture that is limited by opaque body 12.

Operation

The ultrasonic detector (not shown) can be inserted by the ultrasound probe aperture 18 that opaque mask body 12 limits, and is used for light shield apparatus is placed on patient's bladder.It is after in case placement is finished, ultrasonic detector can be removed from light shield apparatus, and light shield is fixing in place.In case be placed in suitable position, ultrasound probe closure 20 can be inserted in the ultrasound probe aperture 18, to reduce the interference that surround lighting is measured NIRS.Yet, carried out ultrasonic listening thereby ultrasound probe closure 20 can regularly move.For example, in the NIRS observation process, determine the volume of bladder.The emitter (not shown) can be inserted into the emitter aperture 14 that is limited by opaque shield 12, and can be fixing by emitter retainer 24, thereby emitter is remained on the position suitable with respect to light shield apparatus.Similarly, the detector (not shown) can be set in the detector aperture 16 that is limited by opaque shield 12, and is fixed in place by detector retainer 26.In case emitter and detector are set in the light shield apparatus, emitter will begin the light towards bladder emission NIRS, and detector detects subsequently.

With reference to Fig. 2 A, wherein show equipment according to another embodiment of the invention by 100 expressions.Fig. 2 A shows the side view of filter tank 102 and selecting arrangement 104,106,108 and 110.Also show the incident illumination guiding device 112 and the output photoconduction leading-in device 114 that enter filter tank 102.

The top view of Fig. 2 A filter plant has been shown among Fig. 2 B.Filter tank 102 and incident illumination guiding device 112 have wherein still been marked.With reference to Fig. 2 C, wherein show the cutaway view of the described filter plant that the line c in Fig. 2 B obtains.Incident illumination guiding device 112 and output photoconduction leading-in device 114 are positioned at relative two ends, filter tank 102.The photoconduction leading-in device is shown as and passes filter tank and crossing respectively with filter actuator rods 128,130,132 and 134, and each actuator lever is respectively from selecting arrangement 104,106,108 and 110 skews.Each actuator lever has filters and non-strain position, on 120,122,124 positions filter is arranged and 126 is non-strain position.

Operation

114 the light that enters the photoconduction leading-in device passes defecator by 100 expressions from 112 to the position, particularly passes filter tank 102.Can activate actuator lever (128,130,132 and 134) by corresponding selecting arrangement (104,106,108 and 110), thereby from the transmission path of post-11.2 in-position 114, selectively locate light filter at the light that passes the photoconduction leading-in device by one or more light filters (120,122,124 and 126).Alternatively, one or more described light filters can be thrown off by described identical selecting arrangement, thereby described light filter is removed from described light transmission path.

Bladder and urinary function disorder

The method of monitoring bladder function of the present invention (bladder urine dynamic monitoring) can be used in particular for relating in the disease diagnosis of bladder and urinary function disorder.The reason that relates to bladder and urinary function dysfunction cases is different, and the limitation of urinating power determination at present also can make diagnosis obscure mutually.Bladder and urinary function disorder may be unusual results on one or more structures of bladder itself or the physiology, or the indication of other dysfunctions of urinary tract (upper urinary tract and lower urinary tract).

The patient who suffers from lower urinary tract dysfunction (LUTD) may suffer from bladder, neck of bladder, prostate and urethra and supply this regional any vessels and neural dysfunction.In addition, the patient who suffers from LUTD may have as people defined (Neurourology andUrodynamics (2002) 21:167-168) lower urinary tract spmptom (LUTS) such as ABRAMS P, at this it is incorporated by reference in this text and examines.The patient who suffers from upper urinary tract dysfunction may and supply this regional any vessels and neural dysfunction at kidney and ureter.Upper urinary tract dysfunction can also comprise the physiological transport of the urine from the kidney to the bladder.The patient who suffers from upper urinary tract dysfunction may have the symptom relevant with this zone.Cause in the reason of upper urinary tract and lower urinary tract dysfunction in measuring patient's body, the monitoring of patient's bladder is most important.

Applicable NIRS monitoring method of the present invention is diagnosed or the type of the urinary function disorder of auxiliary diagnosis can be any lower urinary tract dysfunction or upper urinary tract dysfunction, or is selected from the definition that following world self-control association accepts:

Incontinence: the ability-involuntary urine of the control urine stream of reduction flows out.

Incontinence because of pregnancy: the bladder control problem after the pregnancy.

Child's incontinence: the ability of the control urine stream that in the child, reduces or the ability of uncontrollable urine stream.

Spastic bladder or reflex bladder: have urgent micturition or do not suppress the incontinence of detrusor contractions-can not bear the bladder of normal urine amount, or, therefore wherein always kept some urines by the suitable bladder of emptying.Another kind of such situation is bladder excitation or unsettled, and it can inform that brain is when only being that part just needs the emptying bladder when being full of.

Lack tensile bladder or bladder of flaccid muscles: such state occurs in the bladder 'inertia' and can not emptying the time.The information of filling of bladder is no longer perceived, and bladder too is full of, and this has caused the stretching, extension of bladder muscle and weak.This can cause full and inflow-rate of water turbine incontinence, and it has certain frequency, urgent micturition and leakage or hesitancy.Excessive or when being sent back up (reflux) to kidney when urine, can there be the infection risk that consider, this can cause secular damage.

The bladder of dyssynergia (sphincter dyssynergia): be also referred to as " bladder of contradiction ", because bladder and sphincter are coordinated functionating no longer mutually, their effect is inharmonic.Bladder may contract to emptying, but sphincter also shrinks and preserve urine, and perhaps bladder and sphincter all relax.Symptom comprises urgent micturition and hesitancy afterwards, leakage or incontinence.Sphincter is not opened and is allowed the bladder emptying if suffer from that a major issue of dyssynergia is exactly bladder contraction, has urine so and is back in the kidney.

Sphincter competence is incomplete: corticospinal tract interrupts disturbing the active break (use external sphincter) of urine stream.The sympathetic nerve denervation can disturb the middle part sphincter.Incomplete bladder emptying.

Sphincter vesicae dyssynergia: usually because involuntary detrusor contractions causes incontinence.Sometimes external sphincter and bladder shrink simultaneously, seem to block just as bladder outlet.(less voided volume, the higher back residual quantity of urinating).

(nerve) areflexia of detrusor/low reflection: detrusor areflexia is the bladder that can not produce contraction.The detrusor hyperreflexia is defined as the involuntary detrusor contractions that occurs usually when hanging down amount.This can produce the symptom of urgent micturition or urge incontinence.

Urine retention: bladder emptying problem.Acute urinary retention is sudden can not urinating, and can cause pain and discomfort.Its reason can comprise the obstruction of urinary system, compressing or neurologic problems.Chronic urinary retention is meant that the urine after the incomplete emptying that continues to exist is residual.The common cause of chronic urinary retention is the bladder muscle functional defect, and nerve injury or urinary tract block.

Bladder thorn tumor: in Supravesical benign tumor.

Cystocele: it betides when the wall attenuation between female bladder and the vagina and when making that bladder crashes into vagina.Such situation can cause not accommodating the problem of bladder emptying.In some women, the bladder of tenesmus has extended the opening that enters urethra, cause when the women cough, sneeze, laugh at or carry out arbitrarily can to described bladder exert pressure active the time cause urine leakage.Therefore, bladder can cause the incomplete emptying of two kinds of problems-undesirable urine leakage and bladder from its entopic tenesmus.

Cystitis: bladder infection or inflammation.

Interstitial cystitis: be a kind of chronic bladder disease, be also referred to as painful bladder syndrome and taking place frequently property urgency-dysuria syndrome.In this disease, wall of urinary bladder becomes high-spirited and excitation.Described inflammation can cause the cicatrix and the sclerosis of bladder, reduces bladder capacity, small ulcer hemorrhage and bladder inner face under rare occasion.

Autoimmune interstitial cystitis: autoimmune bladder inflammation.

Neurogenic bladder: control bladder and the nerve of urinating have problem.Described nerve transmits its contraction of information notification or lax from the brain to the bladder muscle.In neurogenic bladder, estimate to transmit the neural cisco unity malfunction of these information.

The bladder of irritable/painful: the symptom of the irritable bladder symptom with interstitial cystitis basically is identical.The nonspecific inflammation that cystoscopy and biopsy results have illustrated does not have the characteristic of interstitial cystitis bladder bead (point is hemorrhage).

Bladder cancer: the cancer of bladder.

Urinary stone: the stone in urinary tract or the bladder.

Neck of bladder blocks: be the reason that causes urinary disturbance, it is that the stenosis or occlusion of neck of bladder (outlet) when urinating causes.

Wet the bed: child or adult's night urination (a kind of form of urinary incontinence is discharged when sleep).

Vesicoureteral reflux: urine normally along a direction flow-descending from kidney, arrive bladder by being called ureteral pipeline.Vesicoureteral reflux is that urine is returned ureteral unusual urine stream from bladder.

Urinary tract infection: the urinary system infection of antibacterial normally.

Urinary tract infection (child): the urinary system infection among the child.

The conventional method that is used for following embodiment

Below the NIRS of explanation monitoring is to use NIRO-300 ^TM, be 1mW in laser power, the pulse duration was 100 nanoseconds, pulse frequency is 2kHz, obtains when being divided into 50mm during the detector/emission from the middle part to the middle part.

The spike of NIRS/ urine stream

The NIRS spike related to before urinating, individual physiological change (being detrusor contractions) after the process neutralization is finished.Variation in the NIRS spike is consistent with the expection physiological change of the detrusor of bladder and associated pipe and nerve.And the spike that obtains from the individuality of suffering from vesical dysfunction has the individual of normal bladder function and is having between the individuality of difference in functionality obstacle obviously different.For example, to cause blocking the spike of individuality of (being Fig. 3 A) completely different with suffering from prostate hyperplasia for the individuality of suffering from nervous bladder (being Fig. 4 B).Conventional urodynamic analysis is based on individual pressure current of discharging and weight (urine stream).Conventional method can not directly be measured bladder function, and the information that is provided often is provided.For example, the spike of urine stream is directly to arrive the record delay of noting down surperficial discharge urine weight by described liquid stream to be limited as everyone knows.

The bladder that blocks

When Peak Flow Rate and mean flow rate all are lower than normal range, this may be because such as prostate hyperplasia block or because the more weak contraction of bladder muscle self causes.Not using conduit to prove under the situation of pressure flow curve (pdet), just can not make evaluation to the reason of weak current.In standard uroflow curve, beginning to urinate up to the patient could acquired information, and the mensuration of described pdet value is invasive.When providing urine flow rate (ml/ second), the standard Urodynamics spike that is also referred to as " urine stream " prolongs when being close with the NIRS spike that is interrupted urinary flow curve fully having of carrying out of patient with of the present invention, need not to take invasive method just can obtain Useful Information.

The NIRS spike (discharges) preceding data that just provide occur in urine, also provides described NIRS data in described standard uroflow curve and the change of generation when not obvious.Urinating preceding about the 15 seconds stage, the further oxidation of Cyt illustrates because the available electron ratio that oxygen needs in the born of the same parents greater than the electronics of guaranteeing to supply with again that substrate provided, has caused the energy of wall of urinary bladder cell needs to increase.Pump under the stage of improving the energy generation with molecular level increase proton this, it is proportional relative oxygen to have occurred, the situation that the substrate ratio lacks, and the parabola that it can be counted as Cyt usually illustrates the rate of deceleration that clean redox state changes.Meanwhile, HbO ₂, Hb and HbSum also decrease, and illustrate owing to detrusor contractions causes the small amounts of blood of bringing of urinating to discharge the blood volume minimizing that causes.In this stage, the minimizing of blood has all reduced the amount of oxygen that uses for Cyt usually, thereby restriction has also reversed the variation in the clean redox state subsequently.

When urinating beginning, common HbO ₂, Hb and HbSum have significant rising, illustrate that the reduction of internal pressure allows angioplerosis, thereby cause the rising of blood flow volume.The oxygen free gas that the blood flow volume that is raise aims to provide capacity stops Cyt to change and brought in substrate electron supply and oxygen to combine (H with proton ₂O) balance.Little by little, the rate variation in the NIRS hemoglobin parameters is slowed down the almost progress not that has illustrated than minor diameter angioplerosis cascade reaction.This may be the increase because of detrusor muscle tension, and it has closed bell's muscle (having stopped urine stream thus) in preparing other detrusor contractions process.

When causing described urine stream temporarily to stop because of the urine that is interrupted stream and when in standard urinary stream, not having measured value, can see physically before the more urine, when muscle contraction, HbO ₂, Hb and HbSum parameter all can reduce.Therefore, Cyt becomes the higher state of oxidation temporarily, and it can finally decompose.

Described patient also has urine stream, and when the urine amount in this moment bladder reduced, because of the lax interior extension of wall of urinary bladder that is organized in causes angioplerosis, rising had appearred in NIRS hemoglobin parameters once more.In the same stage, the redox state of Cyt becomes gradually because most of Cyt molecule has kept electronics and reduces more, although there are a large amount of competent oxygen to can be used to transmit, illustrates that thus the energy requirement (ATP is synthetic) than the described contraction phase is lower.

Because patient's bladder continues emptying, the blood flow volume in described wall of urinary bladder continues to increase, although can not obtain more information from described urine flow data this moment, described NIRS data continue to show the physiological measure in the wall of urinary bladder.When bladder was finished contraction and is in more lax state, because little by little little blood vessel continues lax and becomes full, the blood in the bladder muscle wall can be able to continue to increase.This cascade has reflected the contribution difference of trunk and little blood vessel, because different blood vessel diameters has different sphincter compliance, therefore can not open to simultaneously is enough to store simultaneously blood flow.Just as the above ground, the Cyt level goes on to say lower energy requirement.

Viewed NIRS patterns of change is that physiological is rational, and typical bladder body compliance has been described.And conventional urine flow analysis can only be confirmed to prolong, the urine stream of interruption.

Normal bladder

Normal urine power spike explanation is not having the normal urine stream of the 150-1000cc voided volume under the resid vol situation.The NIRS explanation, in the time will urinating, blood flow volume can increase with the lax of detrusor.In case the peak flow produces, and keeps described peak flow with regard to having slight detrusor contractions, the detrusor contractions that increases gradually that has prolongation is afterwards finished up to urinating.The latter's contraction is softr with the contraction phase ratio that is used for keeping the peak flow with same magnitude, but needs the double persistent period to reach the amplitude that is changed.

Embodiment

NIRS/ urinates stream/pressure tracing

Fig. 3 A-urine stream patient No. 21 (detrusor over activity and the example that is lower than the drainage pressure of normal range)

82 years old elderly men patients have angina pectoris and type ii diabetes history, and suffer from frequent micturition, three grades of (x3) nocturia and prostate hyperplasia (BPH).This patient do not accept at the medical care of bladder treatment.

Be depicted as the standard Urodynamics spike in the bottom of figure, and by described " urine stream " spike representative.Patient's bladder reaches and is full of.This patient has urinary flow curve prolongation and that be interrupted fully.Peak Flow Rate and mean flow rate all are lower than normal range.This may be because such as prostate hyperplasia block or because the more weak contraction of bladder muscle self causes.Just can not make evaluation under the situation of pressure flow curve not using conduit to prove to weak current.Yet, utilize the NIRS spike, can obtain to measure the non-intrusion type device of described weak current reason.Described tatol emiction quantity is 121cc.The volume of the residual urine that records by conduit is 65cc.Before the B of the described standard uroflow curve that described patient begins to urinate point, can not acquired information.

Described NIRS spike also (B point) occur to the same patient urine and was illustrated in preceding 15 seconds, and in the place of NIRS data not obvious (from A to B) described in the described standard uroflow curve, generation changes.In this stage of 15 seconds, Cyt illustrate that by further oxidation the energy that the wall of urinary bladder cell needs increases, this increase be since in the born of the same parents oxygen need the available electron ratio greater than the electronics of guaranteeing to supply with again that substrate provided.Pump under the stage of the energy generation that raises with molecular level increase proton this, the situation that the relative oxygen proportion of substrate ratio lacks occurred, the parabola that it can be counted as Cyt usually illustrates the rate of deceleration that changes at clean redox state.Meanwhile, HbO ₂, Hb and HbSum also decrease, and illustrate owing to detrusor contractions causes the small amounts of blood of bringing of urinating to discharge the blood volume minimizing that causes.In this stage, the minimizing of blood has all reduced the amount of the oxygen that uses for Cyt usually, thereby restriction has also reversed the variation in the clean redox state subsequently, and its variation that takes place immediately after the B point as seen.

When the B point begins to urinate, common Hb, HbO ₂With HbSum remarkable must the rising arranged all, illustrate that the reduction of internal pressure allows angioplerosis, thereby cause the increase (the B point is to the C point) of blood flow volume.The oxygen free gas that the blood flow volume that is raise aims to provide capacity stops Cyt to change (significantly generation immediately after B point) and brought in substrate electron supply and oxygen to combine (H with proton ₂O) balance.In the centre that B point and C are ordered, rate variation slows down the almost progress not that low diameter angioplerosis cascade has been described in the NIRS hemoglobin parameters.This may be the increase because of detrusor muscle tension, and it has closed sphincter of urethra (having blocked urine stream thus) in preparing other detrusor contractions process.

Between C point and D point, because urine stream temporarily stops, so in standard urinary stream, do not have measured value.Yet, be similar to above-described situation of ordering to B from the A point, observing before the urine of D point physical property, when muscle contraction, at the C point to D point, HbO ₂, Hb and HbSum parameter all can reduce.Meanwhile, Cyt becomes the higher state of oxidation temporarily, and it can decompose with identical mode on the above-mentioned B point.

Described patient also has urine stream between D point and E point, and when the urine amount in this moment bladder reduces, extends in the angioplerosis afterwards in lax being organized in the wall of urinary bladder, has occurred rising in the NIRS hemoglobin parameters once more.In the same stage, the redox state of Cyt is because more Cyt molecule has kept electronics and the reduction more that becomes gradually, although there is how competent oxygen to can be used to transmit, illustrate that thus the energy requirement (ATP is synthetic) than described contraction phase (the C point is to the D point) is lower.

Because patient's bladder continues emptying at the E point between the F point, when described NIRS data continued to show physiological measure in the wall of urinary bladder, the blood flow volume in described wall of urinary bladder continued to increase, although can not obtain more information from described urine flow data.We suppose that in this period when bladder was finished contraction and is in the state that more loosens, because little by little little blood vessel is lax continuously and become full, the blood energy in the bladder muscle wall can continue to increase.This cascade has reflected the contribution difference of trunk and little blood vessel, because different blood vessel diameters has different sphincter compliance, therefore can not open to simultaneously is enough to store simultaneously blood flow.Just as the above stage (the D point is to the E point), the Cyt level goes on to say lower energy requirement.

In the viewed NIRS patterns of change of this patient is that physiological is rational, and typical bladder body compliance has been described.NIRS explanation muscle contraction energy demand is normal about 10%, and needs the twice of normal persistent period to start to urinate.NIRS illustrates that also muscle tension/relaxation can not be kept in the process of urinating, and has caused the urine stream that is interrupted thus.And conventional urine flow analysis can only be confirmed to prolong, the urine stream of interruption.

Fig. 3 B-urine stream patient No. 25 (example of normal urine stream, detrusor over activity, urgency incontinence and normal baric flow)

62 years old old women patients suffer from the frequent and urgency incontinence history of urgent micturition.

Described standard Urodynamics spike illustrates that described patient has the urinary flow curve of prolongation.Tatol emiction quantity is 360cc.In described patient's body, shift out residual 55cc urine with conduit then.

NIRS explanation from the A point to the B point, when muscle contraction and blood are forced out wall of urinary bladder, HbO ₂, Hb and HbSum also decrease.Cyt is further oxidized, illustrates that muscle has used more oxygen to satisfy the energy requirement that starts the contraction of urinating stream.At the C point, begin to urinate, be accompanied by proportional blood flow volume (HbO ₂, Hb and HbSum) increase gradually and the reduction gradually of Cyt, the lax of wall of urinary bladder has been described.Between D point and E point, blood flow volume obviously increases, and has seemingly reflected the lax of integral body that bladder returns along with blood flow.Between D point and E point, Cyt is also further reduced, and this has supported the lax prediction of bladder muscle.Between E point and F point, NIRS continues to collect the data of bladder state, although standard Urodynamics can not obtain any other information.Variation in the observed on one's body NIRS pattern of described patient has the physiology reasonability, and typical bladder body compliance has been described.In the peak stream stage, detrusor muscle tension remains unchanged always, reduces gradually in the process of finishing of urinating then, and finishes the back and relax fast urinating.

Fig. 4 A-urine stream patient No. 26 (example of normal urine stream and detrusor over activity)

The patient is 67 years old old women, suffers from frequent micturition, urgent micturition and incontinence (non-oppressing incontinence) history.

Described standard Urodynamics spike illustrates that this is normal female urine stream.Described patient has the urinary flow curve of normal shape.Maximum stream flow is 22cc/ second, average out to 10cc/ second.Tatol emiction quantity is 411cc, and residual quantity is 45cc.

NIRS explanation from the A point to the B point, when detrusor contractions is prepared to urinate, HbO ₂, Hb and HbSum decrease, and the clean redox state of Cyt increases to some extent.At the B point, begin to urinate, the lax blood flow volume that is accompanied by bladder muscle rises to some extent.Between C point and D point, begin to attempt the effort of emptying residue urine, blood flow volume reduces when muscle contraction, is accompanied by energy requirement Cyt also further oxidized (slower, but be similar in the situation of A point to the observation of B point).At the D point, bladder is emptying, and the standard urinary flow data stops immediately.The NIRS data continue, and the blood flow volume that shows when bladder muscle is lax increases.When described energy requirement reduced, Cyt also becomes, and a little reduced more.

Variation in the observed on one's body NIRS pattern of described patient has the physiology reasonability, and typical bladder body compliance has been described.After having begun 6 seconds in case urinate, detrusor muscle tension will raise and last till the peak value of urine stream, continues then slightly to raise till the bladder emptying gradually.

Fig. 4 B-urine stream patient No. 27 (example of neurogenic bladder)

The patient is 72 years old elderly men, suffers from the spinal cord injury history.

Described standard Urodynamics spike explanation maximum stream flow is 7cc/ second, and average discharge is 4cc/ second.Tatol emiction quantity is 74cc, and residual quantity is 100cc.

NIRS explanation data collection is more rough than normal data setting.Bladder may be just in spasm.Yet typical NIRS emptying pattern is still apparent in view.To between the B point, the patient is attempting to begin to urinate at the A point, when described muscle contraction, and blood flow volume (HbO ₂, Hb and HbSum) decrease, and when energy requirement raise, Cyt was further oxidized.At the B point, the beginning small amount of urination.Different with other patients that raise at this blood flow volume, because of this patient initiatively shrinks bladder muscle, blood flow volume continues to reduce.Between B point and C point, a stage of slightly rising is arranged, this might relate to the lax of short time.Before the C point, when described patient's indication is finished, because of bladder muscle is lax, reduction more that blood flow volume raises and Cyt becomes.

Variation in the observed on one's body NIRS pattern of described patient is that physiological is rational, and the favorable tissue compliance corresponding with changing speed preferably has been described.Detrusor contraction energy demand is normal 25% and than normal development slow 1.6 times.Be subjected to the slight detrusor contractions that raises, the initial enhancing of urine stream, described contraction lasts till the peak value of urine stream always, then urine stream stop loosening before, also have brief contraction to increase, before some residual urine amount is discharged, also have the contraction of prolongation once more to increase simultaneously, after this detrusor loosens, and no longer urinates.

Fig. 5 A-urine stream patient No. 28 (prolonging the example of (but almost normal) urine stream)

The patient is 34 years old women, suffers from frequent micturition, interstitial cystitis history, no incontinence history.

Described standard Urodynamics spike illustrates that this is that reasonably urine flows.Maximum stream flow is 14cc/ second, and average discharge is 9cc/ second.Voided volume is 212cc, and residual quantity is 5cc.

NIRS explanation from the A point to the B point, when bladder muscle is loosened, blood volume (HbSum, Hb, HbO ₂) sharply raise, and when the energy requirement to muscle reduced, Cyt became and reduces more.Between B point D point, there are several ripples that muscle contraction and lax circulation have been described.Although Hb is changing always, compare its amplitude of variation with other patients and reduce.After finishing when urinating, blood flow volume continues to raise gradually, the Cyt reduction more that becomes then of oxidation more that becomes earlier.Compare the hysteresis that the changing pattern of Cyt was had an appointment 10 seconds with other patients.In whole process, the amplitude of variation of Cyt is bigger.This may reflect pathological difference.

Variation in the observed on one's body NIRS pattern of described patient has the physiology reasonability, and typical bladder body compliance has been described.In case urine stream peak occurred, detrusor contractions will be recovered, and keeps stable in the process of urinating that continues.Because bladder near emptying, of short duration lasting further contraction can occur, in case the bladder emptying will be loosened then.

Fig. 5 B-urine stream patient No. 30 (slowly beginning to urinate the example of stream)

The patient is 30 years old women, suffers from urgent micturition, frequent micturition and some incontinence histories.

Described standard Urodynamics spike illustrates that described patient has the urinary flow curve of prolongation.Maximum stream flow is 17cc/ second, and average discharge is 9cc/ second.Tatol emiction quantity is 469cc, and residual quantity is 50cc.

NIRS illustrates that its changing pattern is different with other people basically.At the A point between the B point, before urine stream beginning, HbO ₂A small amount of rising is arranged.Because urine stream rises HbO to some extent between B point and C point ₂Rising more quickly.In whole process, the amount of Hb does not have to change substantially.The oxidation level of Cyt also has corresponding slightly increase, and this demonstrates and the difference that does not have the patient of urgent micturition once more.Between C point D point, bladder muscle shows to be loosened, and with the rising of Hbsum, and the rising of lower Hb.At the D point, urinate stop after, the reduction of Hbsum has appearred, reflected that final active shrinks to attempt to drain residual urine.Yet Cyt becomes and reduces more.This might reflect pathological state, and wherein the supply and demand of oxygen is also uneven, and this may be the vein blood vessel result of damage in the past.

Variation in the observed on one's body NIRS pattern of described patient is that physiological is rational, and has illustrated and the corresponding typical bladder body compliance of amplitude of variation.NIRS has illustrated passive the urinating when not using detrusor contractions, although before peak urine stream some contractions are arranged also; Illustrated that also detrusor more obviously shrinks when finishing in case urinate in order to reduce the fragmentary seepage of residual urine.

Filling bladder internal pressure measurement figure (CMG) lies on the back

No. 21, Fig. 6 A-supine patient (example that has the low systolic pressure of low flow velocity because block)

The patient is 82 years old elderly men, suffers from angina pectoris and type ii diabetes history, and suffers from frequent micturition, three grades of nocturia and prostate hyperplasia (BPH).Do not accept to be directed to the therapeutic treatment of bladder.

Described standard Urodynamics spike has provided PDet, its reflection be the bladder pressure that causes by bladder muscle, illustrate that in the elapsed time be at 22 o'clock, just in time before filling of bladder is felt in patient indication, unsettled bladder contraction (peak value of PDet) has appearred, spontaneous disappearance after such contraction.In blink afterwards, described patient has felt that urgent micturition, bladder pressure begin to increase, and patient's indication bladder on that of " say and be full of " is in heap(ed) capacity.

The NIRS explanation is because bladder is full of, so HbO ₂The Hb that rises to some extent then descends to some extent.After unsettled bladder contraction, described patient recognize be full of before, have one section stable the time.In this, HbO ₂Have slightly violent the rising.Surpass this point, HbO ₂Will descend, the speed of its decline can change after urgent micturition is felt in patient's report.It should be noted that and feel described patient and to have an of short duration plateau when being full of this point with urgent micturition.When described patient illustrates that he has been full of, HbO ₂Can keep stable.When wall of urinary bladder stretches attenuation when holding bigger capacity, Hb has corresponding reduction.

No. 22, Fig. 6 B-supine patient (example that has the high systolic pressure of low flow velocity because block)

The patient is 65 years old elderly men, suffers to block and urgency incontinence.

Described standard Urodynamics spike illustrates that described patient suffers from urgent micturition, and described PDet collection of illustrative plates explanation exists detrusor too active.

The NIRS explanation is because bladder begins to be full of, so HbO ₂With Hbsum slight decline is arranged all.In whole this stage, it is constant that Hb keeps.At HbO ₂All keep stable that patient and can be appreciated that being full of with Hbsum, Cyt further is reduced simultaneously.Described patient feels urgent micturition and begins non-active to leak (urgency incontinence).Because the bladder pressure that seepage causes reduces,, described patient suppresses urine thereby beginning to attempt to resist non-active leakage.HbO ₂Turn back to baseline with Hbsum.After several seconds were resisted in leakage, described patient urinated by the conduit activity, and this trial has reduced the blood flow volume in the wall of urinary bladder, and the Cyt oxidation more that becomes has simultaneously illustrated the consumption of energy.HbO ₂Sharply descend with Hbsum, Hb also descends.Leak when resisting urine when described patient resists, detrusor pressure (PDet) also reduces.When PDet reaches platform and HbO ₂When turning back to baseline with Hbsum, Cyt also turns back to baseline gradually.

No. 23, Fig. 7 A-supine patient (detrusor over activity, urgency incontinence, high systolic pressure and the example that blocks)

The patient is 55 years old elderly men, suffers from sialorrhea behind the flow velocity, frequent micturition, drainage of reduction.

During described standard Urodynamics spike explanation full in normal range, detrusor pressure has obviously increase step by step.Indicate it to be in up at the about 90cm H of pressure the patient ₂When having seen the capacity of seepage during O, detrusor pressure raises fast.

The NIRS explanation is full full to sensation from opening, Hb, HbO ₂With all then increases gradually of the oxidation of decline Cyt gradually of Hbsum.After described patient's indication is felt to be full of, HbO ₂Descend rapidly with Hbsum, and continue to descend fast till described patient's indication has reached capacity.Ironically, in this patient, feel the data that void value must write down on that of urgent micturition in its indication.Reach capacity after a while, HbO in this patient's indication ₂Then continue the oxidation more that becomes with the unexpected Cyt that raises of Hbsum.In all stage, Hb is obviously reducing gradually.Hb just arrives the back with HbO at capacity ₂Rising and begin to raise the unexpected rising of prompting blood volume.Before seepage began, Cyt became and reduces more, and the reduction of muscle institute energy requirement has been described.When PDet reduces (HbO with clean oxidation ₂Reduce and the Hb rising) when turning back to baseline, Hbsum and Cyt also turn back to baseline.

No. 24, Fig. 7 B-supine patient (example of involuntary detrusor contractions)

The patient is 65 years old elderly men, suffers from unwilled detrusor contractions and overflow urinary incontinence.Described patient has sensation for the first time when 173cc, never reach the sensation of urgent micturition or capacity, although 500cc (maximum safe infusion limit) is arranged in the bladder.

The cystospasm that described standard Urodynamics spike explanation is seen in PDet is when detrusor shrinks off and on and loosens, HbO ₂In NIRS change and to reflect, described shrink off and on and relax blood can be compressed muscle and also allow blood to turn back to muscle subsequently.

NIRS in general, when PDet and Bladder Volume increased along with being full of, the blood flow volume in the bladder muscle descended, and is consistent with the attenuation of wall of urinary bladder and caused narrowing down of blood vessel subsequently.In whole process, Cyt increases oxidation gradually, and the Hb maintenance is constant.We suppose that this has illustrated possible electron transport cascade, in default of substrate (because bladder does not store substrate).

No. 25, Fig. 8 A-supine patient (example of normal urine stream, detrusor over activity, urgency incontinence and normal pressure stream)

The patient is 62 years old old women, suffers from the frequent and urgency incontinence history of urgent micturition.

The NIRS explanation does not all have significant change in any NIRS parameter in whole full process.When the described patient Shi Caihui that sits straight changes, but this may be an illusion, because when the patient changes posture, bladder also can change shape and position.When described patient haves no alternative but by conduit seepage (incontinence), HbO ₂Reduce with Hbsum and Hb remains unchanged.Cyt becomes at the beginning and reduces more, and it is stable to become then.In the time of will finishing when urinating, bladder loosens, and blood flow volume raises.After the seepage, detrusor pressure begins to raise once more, is accompanied by such rising, and blood flow volume reduces once more.

No. 26, Fig. 8 B-supine patient (example of normal urine stream and detrusor over activity)

The patient is 67 years old old women, suffers from frequent micturition, urgent micturition and incontinence (not being stress incontinence) history.

Described standard Urodynamics spike explanation detrusor pressure in full process is immobilized, except detrusor pressure after compressing for the first time has small increase.

NIRS explanation oxygenation parameters in whole process all is stable.This is an approaching normal patient.Yet when the pressure of detrusor raise, blood flow volume had small size reduction.After once shrinking (detrusor pressure rising), blood flow volume can turn back to baseline.This small size change can illustrate the minor variations of bladder wall thickness, perhaps with this patient vessel compliance is arranged.Described patient does not reach " capacity ".

CMG seat and pressure current

The patient of Fig. 9 A-sitting No. 21 (example of bad flesh compliance)

The patient is 82 years old elderly men, suffers from angina pectoris and type ii diabetes history, and suffers from frequent micturition, 3 grades of nocturia and prostate hyperplasia (BPH).Do not accept to be directed to the therapeutic treatment of bladder.

The research of described standard Urodynamics spike explanation pressure current starts at " beginning to urinate " point.In described patient, before turning back near baseline, PDet is increased to similar 110cmH at the beginning ₂O.

NIRS illustrates when bladder contraction, HbO ₂, Hb and Hbsum reduce rapidly suddenly.HbO subsequently ₂Having illustrated laxly with the rising of Hb, is to follow HbO then ₂That reduces shrinks again.Yet Hb begins to raise gradually, illustrates that muscle begins to relax.Almost can see less several times bladder/contraction circulation in the emptying at bladder.Cyt becomes at the beginning and reduces more, and it is stable to become then, and is consistent with the initial energy demand of shrinking.

The patient of Fig. 9 B-sitting No. 23 (detrusor over activity, urgency incontinence, high systolic pressure and the example that blocks)

The patient is 55 years old elderly men, suffers from sialorrhea behind the flow velocity, frequent micturition, drainage of reduction.

Described standard Urodynamics spike explanation detrusor over activity occurred and has raise with significant pressure after described patient feels that the first time urgently.Described patient can not suppress bladder contraction, so begin to urinate.During this time, occurred following the bladder pressure of the unanimity of urinating to descend.

NIRS illustrates in whole research process, HbO ₂All reducing gradually, up to PDet turn back to be bordering on the patient and begin to feel the level of urgent micturition till, blood flow volume remains unchanged then.When full stopping, Cyt begins to become and reduces more, becomes stable when urinating beginning.Soon Hb begins to raise after the beginning of urinating.

The patient of Figure 10 A-sitting No. 24 (example of involuntary detrusor contractions)

The patient is 65 years old elderly men, suffers from unwilled detrusor contractions and overflow urinary incontinence.

Described standard Urodynamics spike explanation has proved more weak bladder sensation once more at the repetition CMG of sitting posture.

The NIRS explanation does not have significant detrusor contractions when described patient attempts to urinate, described then patient attempts to urinate by the abdominal part contraction.This is reflection to some extent in more smooth Pdet line, when he attempts to force urine to discharge (" promotion "), can notice the obvious increase that abdominal part shrinks by NIRS.Do not see actual urine stream.In described contraction process, the rising and the reduction (square frame of dotted line) of interruption are arranged in NIRS, may reflect the pressure that shrinks from abdominal part impact effect to blood flow volume in the detrusor.When described patient is actual when urinating, the blood flow volume in detrusor sharply raises, and the oxidation level of Cyt also has increase, and the energy requirement that increases has been described.After the process of urgently urinating, the NIRS data are back to baseline.

The patient of Figure 10 B-sitting No. 25 (example of normal urine stream, detrusor over activity, urgency incontinence and normal pressure stream)

The patient is 62 years old old women, suffers from the frequent and urgency incontinence history of urgent micturition.

Described standard Urodynamics spike explanation is in the full stage of described CMG, and Pdet is immobilized relatively.When with 20cm H ₂When O urinated, detrusor initiatively shrank.Described pressure flow curve is in normal range.

NIRS explanation is in whole full process, and the NIRS data almost do not change, and except blood flow volume before the small size contraction of detrusor can increase on a small quantity, is full of and during the wall of urinary bladder attenuation, blood flow volume reduces gradually when bladder then.When full stopping, blood flow volume can slightly increase up to beginning initiatively shrink urinate till.We can see that blood flow volume can raise once more when described contraction is lax, and continue to increase after the bladder emptying.

Non-Pathologic Cases

Figure 11 A-urine stream 1 st volunteer, test for the first time (normal example)

The patient is 50 years old old women, and is healthy, no urology disease.

Described standard Urodynamics spike has illustrated the normal urine stream of 370cc voided volume, does not have residual urine.

The NIRS explanation, to the B point, when beginning to urinate, the lax blood flow volume that is accompanied by detrusor can increase from the A point.In case peak miscarriage is given birth to, thereby have slight detrusor contractions described peak stream is maintained to the B point in the centre that A point and B are ordered, have the detrusor contractions of increase gradually of prolongation afterwards, urinate up to finishing at the C point.The latter's shrinkage ratio is used to keep the contraction of flowing at the peak and wants gentle, and described shrinkage degree is identical, but needs the persistent period of twice to arrive described change degree.Urinate finish after one minute, visible brief lax pulse (D point).

Figure 11 B-urine stream 1 st volunteer, test for the second time (normal example)

The patient is 50 years old old women, and is healthy, no urology disease.

Described standard Urodynamics spike has illustrated the normal urine stream of 342cc voided volume, does not have residual urine.

The NIRS explanation, to the B point, the blood flow volume in the detrusor increases, and detrusor and sphincteral loosening is described, thereby has caused not having the passive of detrusor contractions to be urinated from the A point.Just before the B point, when urinating beginning, blood flow volume begins to reduce, and illustrates that the part of detrusor is shunk.After the B point, contraction becomes stronger, urinates in arriving peak stream.Less several times contraction is arranged after this, and therefore described patient feels emptying, thereby and then initiatively shrinks and determine emptying.Contraction subsequently is similar to the rhythmical contraction in back of urinating normally.

Although particular of the present invention is described and illustrates, these embodiments are also only as to explanation of the present invention, and should the invention of claims instruction not limited.

Claims (27)

1. monitor the method for bladder function in having the animal of bladder, described method comprises:

(a) optical transmitting set and photodetector are positioned at contiguous animal's bladder place;

(b) detect light with described optical transmitting set at described bladder emission light and with described photodetector; And

Detect the representative data of light when (c) being collected in the bladder activity, thereby the indication of bladder function is provided.

2. the method for claim 1, wherein said only near infrared (NIR), described optical transmitting set are near infrared spectrum (NIRS) emitters, described detector is that NIRS detector and described data are NIRS data.

3. method as claimed in claim 1 or 2, wherein said detector are positioned on the animal skin of contiguous described animal's bladder.

4. as the described method of arbitrary claim among the claim 1-3, wherein said only coherent light.

5. as the described method of arbitrary claim among the claim 1-4, wherein said location is finished by ultrasound wave.

6. as the described method of arbitrary claim among the claim 1-4,10mm side and wherein said animal that wherein said location is positioned at described animal pubic symphysis are the adults.

7. method as claimed in claim 5, wherein said ultrasonic locating comprises:

(a) from transducer emission ultrasonic energy; And

(b) thus receive the position that the ultrasonic energy reflected is measured described animal's bladder.

8. method as claimed in claim 2, the NIR light of wherein being launched is between the 750-790 nanometer.

9. as the described method of arbitrary claim among the claim 2-8, wherein collected NIRS data are oxygen and hemoglobin (HbO ₂); Deoxyhemoglobin (Hb); Oxidation cytochrome a, a3; Reduction cytochrome a, a3; The oxidation of cytochrome C oxidase subtracts the indication of one or more levels in described animal of reduction form (Cyt).

10. method as claimed in claim 2, wherein said location comprise uses described NIRS emitter of light barrier protection and described NIRS detector, thereby prevents the collection of ambient light interference NIRS data.

11. as the described method of arbitrary claim among the claim 1-10, wherein also be included in the light that weakens and launched before the described bladder place emission light, described thus reduction can be suitable for compensating the variation of described animal physical parameter.

12. method as claimed in claim 11, wherein said reduction are to realize by filtering the light of being launched.

13. method as claimed in claim 12, the filtration of wherein said light are light emitted with operationally increase filtering institute, have that the filter tank of selectable variable density filter realizes.

14., also comprise the ultrasonic measuring that obtains described animal's bladder parameters as the described method of arbitrary claim among the claim 1-13.

15. as the described method of arbitrary claim among the claim 1-14, the location of wherein said optical transmitting set and described photodetector makes the about 15-90mm of being spaced apart of described optical transmitting set and described photodetector.

16. light shield apparatus, described equipment comprises:

(a) opaque shield, it has emitter aperture, detector aperture and ultrasound probe aperture, wherein said emitter aperture, detector aperture and ultrasound probe aperture allow near the localized area on the animal skin, and described light shield apparatus is applied to described localized area

(b) emitter retainer, thereby it operationally remains on the NIRS emitter and makes the position of described NIRS emitter near the emitting surface on the described animal skin within the described emitter aperture, and wherein said emitter retainer operationally reduces the interference of described emitting surface surround lighting; And

(c) detector retainer, it operationally remains on the NIRS detector within the described detector aperture and with described NIRS emitter separates, thereby make the position of described NIRS detector near the surveyed area on the described animal skin, the light that wherein said detector retainer operationally reduces around the described emitting surface disturbs.

17. equipment as claimed in claim 16, also comprise ultrasound probe closure with position of the switch, described ultrasound probe closure operationally allows the ultrasonic surface of ultrasonic detector on the approaching described animal skin in the position of opening, and operationally reduces described ultrasonic surface light on every side in the position of described pass and disturb.

18., also comprise operationally described light shield is remained on away from described zoodermic attachment arrangement as claim 16 or 17 described equipment.

19. as the described equipment of the arbitrary claim of claim 16-18, wherein said attachment arrangement is selected from diaper, adjustable belt, adjustable belt system, viscosity glue, adhesive tape, electrostatic charge, vacuum draw and stressed Mk system.

20., also comprise the interface cable holdout device as the described equipment of the arbitrary claim of claim 16-19.

21. as the described equipment of the arbitrary claim of claim 16-20, thereby wherein said launch hole and described detector aperture make about 15-90mm that is spaced apart of described NIRS emitter and described NIRS detector at interval.

22. to the filter plant that the NIR light of being launched by the near infrared light emitter weakens, described equipment comprises:

(a) filter tank, described filter tank comprises a plurality of variable density filters, the NIR light that operationally increases launching from described total unfiltered output illumination filters; And

(b) selecting arrangement can be positioned one or more described a plurality of variable density filters on the light path of the NIR light launched thus.

23. equipment as claimed in claim 22, wherein said filter tank comprises a series of slidably light filters with strain position and non-strain position, and wherein said selecting arrangement comprises actuating device, and described actuating device operationally optionally slides into described strain position or described non-strain position with the variable density filter of one or more described majorities.

24. as claim 22 or 23 described equipment, the incremental step of wherein said a plurality of variable density filters is selected from described total not filtering and exports 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9% and 10% of illumination.

25. equipment as claimed in claim 24, the incremental step of wherein said a plurality of variable density filters are described total 6% of output illumination of not filtering.

26. equipment as claimed in claim 24, the incremental step of wherein said a plurality of variable density filters are described total 7% of output illumination of not filtering.

27. equipment as claimed in claim 24, the incremental step of wherein said a plurality of variable density filters are described total 5% of output illumination of not filtering.

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