Cyclooxygenase-2 dependent and independent antitumor effects induced by celecoxib in urinary bladder cancer cells

Transitional cell carcinoma of the urinary bladder is the second most common genitourinary malignancy in people in the United States. Cyclooxygenase-2 (COX-2) is overexpressed in bladder cancer. COX-2 inhibitors have had antitumor activity against bladder cancer, but the mechanisms of action are unclear. Clinically relevant concentrations of COX-2 inhibitors fail to inhibit proliferation in standard in vitro assays. In pilot experiments, different culture conditions [standard monolayer, modified monolayer, soft agar, collagen, and poly(2-hydroxyethyl methacrylate)-coated plates] were assessed to determine conditions suitable for the study of COX inhibitor growth-inhibitory effects. This was followed by studies of the effects of clinically relevant concentrations of a selective COX-2 inhibitor (celecoxib) on urinary bladder cancer cell lines (HT1376, TCCSUP, and UMUC3). Celecoxib (相似文献   

Comparative impact on prostanoid biosynthesis of celecoxib and the novel nonsteroidal anti-inflammatory drug CG100649

Nonsteroidal anti-inflammatory drugs (NSAIDs) elevate cardiovascular risk by disrupting cyclooxygenase-2 (COX-2)-dependent biosynthesis of prostacyclin (PGI(2)). CG100649 is a novel NSAID proposed to inhibit both COX-2 and carbonic anhydrase (CA)-I/-II. We compared its impact on prostanoid biosynthesis with that of celecoxib, an NSAID purposefully designed to selectively inhibit COX-2. In a controlled, double-blind randomized trial, single oral doses of 2 or 8 mg CG100649, 200 mg celecoxib, or placebo were well tolerated by healthy volunteers (n = 23). Both CG100649 and celecoxib had the effect of depressing urinary excretion of 2,3-dinor-6-keto-PGF(1α) (PGI-M); the effect of CG100649 was dose-dependent and more sustained (up to 240 h after the dose) than that of celecoxib. Neither CG100649 nor celecoxib significantly inhibited COX-1-dependent prostanoid formation. CA inhibition was not detected after administration of CG100649, despite its partitioning asymmetrically into erythrocytes. CG100649 and celecoxib are both relatively selective inhibitors of COX-2, but they differ in duration of action. Whether they have similar impact on cardiovascular events remains to be determined.     

Benign prostatic hyperplasia and urinary symptoms: Evaluation and treatment

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting middle-aged men. This condition can be microscopic, macroscopic, symptomatic, or asymptomatic. Up to 15% to 25% of men aged 50–65 years have lower urinary tract symptoms (LUTS) consisting of nocturia, urgency, frequency, a sensation of not completely emptying the bladder, stop-start urination, straining to urinate, a need to urinate soon after voiding, and weak urinary stream. These symptoms usually are associated with benign enlargement of the prostate gland that is of sufficient severity to interfere with a man’s quality of life. Although LUTS is often associated with BPH, LUTS can also be due to various unrelated syndromes such as heart failure, urinary tract infections, and diabetes. Most men will have benign hyperplasia of the prostate gland and this benign growth compresses the urethra resulting in LUTS. This article will discuss the evaluation, pharmacological management, minimally invasive treatment, and surgical therapy of this common condition affecting millions of American men.     

Transurethral resection of the prostate: failure patterns and surgical outcomes in patients with symptoms refractory to alpha-antagonists

BACKGROUND: alpha-Antagonists (AAs) are ineffective in some men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) may be required. Reasons for AA failure and surgical outcomes in these patients have not been reported. METHODS: We retrospectively reviewed cases of TURP for LUTS due to bladder outlet obstruction from 1995 to 1998. The TURP patients in whom AA therapy had failed (group 1) were compared with those who had symptomatic BPH but were not taking AAs (group 2). Comorbid conditions that might influence treatment results were considered, as were sizes of resection and pathologic results. RESULTS: No differences occurred between groups 1 (n = 38) and 2 (n = 25) in age, length of postoperative follow-up, or resection size. However, outcomes were poorer in group 1 than in group 2. A trend toward greater comorbidity that might lead to voiding dysfunction, though not statistically significant, was seen in group 1. CONCLUSIONS: Postoperative results of TURP may be less successful after AA therapy failure. This may be due to preoperative risk factors that affect voiding function rather than to prostatic size.     

Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions

Introduction: In recent years, there has been an increased interest in the use of botulinum neurotoxin (BoNT) to treat medical conditions refractory to conventional treatment. The following article provides an overview of the clinical use and efficacy of BoNT in the treatment of various urologic and sexual conditions.

Areas covered: BoNT has been accepted and/or explored as novel treatment for various lower urinary tract and sexual dysfunctions such as overactive bladder/detrusor overactivity (DO), detrusor-sphincter dyssynergia (DSD), benign prostatic hyperplasia, interstitial cystitis/painful bladder syndrome, chronic pelvic pain and more recently premature ejaculation. The following terms ‘botulinum toxin’, ‘BoNT’, ‘botulinum toxin A’, ‘Botox’, ‘Dysport’, ‘Xeomin’, ‘botulinum toxin B’, ‘Myobloc’, ‘OnabotulinumA’, ‘RimabotulinumA’, ‘IncobotulinumA’ and ‘AbobotulinumA’ were used to search several databases including MEDLINE, Pubmed, EMBASE, CINAHL and clinicaltrials.gov for inclusion in this review article. Only English language articles were considered and all studies were limited to BoNT therapy in urological conditions in the adult population.

Expert opinion: BoNT-A has received regulatory approval for use in neurogenic DO and overactive bladder, but its use remains unlicensed in other lower urinary tract conditions such as non-neurogenic lower urinary tract symptoms in men with benign prostatic hyperplasia, bladder pain syndrome and DSD. Published literature shows that BoNT can be effective in carefully selected patient groups, has minimal adverse event profile and is generally well tolerated by many patients. However, many questions remain unanswered and larger scale multi-institutional studies are required to determine the key factors in BoNT treatment success.     

Haemangiomas in the urinary bladder: Two case reports

BACKGROUNDUrinary bladder haemangioma is a benign nonurothelial tumour that rarely occurs in paediatric and adolescent patients. Clinical and radiological examinations are not adequate for an accurate diagnosis. The purpose of this serial case report is to raise awareness of urinary bladder haemangioma and appropriate management.CASE SUMMARYWe described two rare cases of urinary bladder haemangioma that were confirmed by histopathology followed by immunohistochemistry and reviewed the literature on the diagnosis and treatment of patients with this disease. The radical cystectomy was performed with open method surgery associated with an abdominal wall ostomy of the ileal outlet tract for case 1. Case 2 underwent a laparoscopic partial cystectomy. Postoperative pathology confirmed the diagnosis of urinary bladder haemangioma. Haematuria resolved postoperatively, and there was no evidence of tumour recurrence in 3 years follow-up for case 1. Postoperative urinary and pelvic ultrasonography showed no signs of recurrence in 3 mo follow-up for case 2.CONCLUSIONCareful histopathological and immunohistochemical studies are required to establish the correct diagnosis. There is no “gold standard” treatment for urinary bladder haemangioma, and treatment options are varied for individuals with favourable follow-ups.     

The diagnostic value of abdominal ultrasound,urine cytology and prostate‐specific antigen testing in the lower urinary tract symptoms clinic

Introduction: Lower urinary tract symptoms (LUTS) affect 18–26% of men aged 40–79 years, many of whom present with a fear of having cancer. Current guidelines for the assessment of LUTS focus mainly upon benign prostatic hypertrophy. It has been our practice to perform an abdominal ultrasound scan (USS), a prostate‐specific antigen (PSA) blood test and urine cytology during the assessment of males presenting with LUTS to investigate the alternative potentially life‐threatening causes for LUTS. We report on the added value of these tests during the assessment of men with LUTS. Results: A total of 263/3976 (6.6%) patients investigated for LUTS were found to have incidental urological malignancies, urinary tract calculi or abdominal aortic aneurysms (AAA). Abdominal USSs resulted in the incidental diagnosis of four renal carcinomas (0.1%), 45 AAAs (incidence = 1.1%) and 44 urinary tract calculi (1.1%). Urine cytology testing and bladder USSs helped diagnose 17 new bladder cancers (0.4%), five of which did not present with haematuria. Patients found to have an elevated age‐specific PSA had a 23.6% chance of being diagnosed with prostate cancer (3.8%). Conclusion: The addition of abdominal ultrasound scanning, urine cytology and PSA testing as part of an LUTS assessment protocol can help to diagnose significant, potentially life‐threatening conditions in up to 6.6% of patients. While the pick up rate of each individual condition is not higher in the LUTS patient than in the general population, the combined pick up rate may justify these additional investigations.     

In vitro and in vivo inhibitory effect evaluation of cyclooxygenase-2 inhibitors,antisense cyclooxygenase-2 cDNA,and their combination on the growth of human bladder cancer cells

Overexpression of cyclooxygenase (COX)-2 is associated with the progression of various malignancies, but the contribution of COX-2 expression, bioactivity or their cooperation to bladder cancer growth calls for further clarification. In this study, we investigated the inhibitory effect of COX-2 inhibitors, antisense COX-2 nucleotide, and their combination on the growth of bladder cancer cells (5637, 5637-P and 5637-AS). Suppression of either COX-2 expression or activity caused reduced cell proliferation, enhanced cell numbers in G₁ phase, and increased apoptosis; the joint suppression of COX-2 expression and bioactivity enhanced the degree of cell growth inhibition. COX-2 antisense-expressing 5637-AS tumors showed a 41.42 ± 3.08% growth inhibition as compared with 5637 controls. Oral administration of indomethacin (3 mg/kg) or celecoxib (15 mg/kg) caused tumor growth inhibition by 31.5 ± 14.87% or 83.17 ± 1.17%, respectively. When COX-2 antisense cDNA and COX-2 inhibitor celecoxib were combined, the tumor growth inhibition rate was further increased up to 88.78 ± 3.10%. These results provide evidence that celecoxib has potential therapeutic effect on bladder cancer, and the joint use of COX-2 antisense cDNA with celecoxib may improve their individual therapeutic effect, especially significantly increase the growth inhibitory effect of COX-2 antisense cDNA.     

两种康复护理方案在颈髓损伤合并神经源性膀胱患者中的应用

目的探讨两种康复护理方案在颈髓损伤合并神经源性膀胱患者中的应用效果。方法选取2017年8月至2018年12月在我院接受住院治疗的颈髓损伤合并神经源性膀胱的患者90例为研究对象,随机分成观察组46例和对照组44例,观察组采用扳机点膀胱功能训练结合间歇导尿法,对照组采用Crede膀胱功能训练结合间歇导尿法,比较两组患者在治疗后的膀胱最大容量、残余尿量和最大排尿量、尿路感染和尿路结石情况。结果观察组患者残余尿量少于对照组,膀胱最大容量和最大排尿量优于对照组(P<0.05),尿路感染及尿路结石发生率低于对照组(P<0.05)。结论应用扳机点膀胱功能训练结合间歇导尿法和Crede膀胱功能训练结合间歇导尿法对颈髓损伤合并神经源性膀胱患者进行治疗均有效,但应用扳机点膀胱功能训练法结合间歇导尿效果更好,并发症显著减少,值得推广应用。     

Synergistic anticancer effects of combined γ-tocotrienol and celecoxib treatment are associated with suppression in Akt and NFκB signaling

The selective cyclooxygenase (COX)-2 inhibitor, celecoxib, and the vitamin E isoform, γ-tocotrienol, both display potent anticancer activity. However, high dose clinical use of selective COX-2 inhibitors has been limited by gastrointestinal and cardiovascular toxicity, whereas limited absorption and transport of γ-tocotrienol by the body has made it difficult to obtain and sustain therapeutic levels in the blood and target tissues. Studies were conducted to characterize the synergistic anticancer antiproliferative effects of combined low dose celecoxib and γ-tocotrienol treatment on mammary tumor cells in culture. The highly malignant mouse +SA mammary epithelial cells were maintained in culture on serum-free defined control or treatment media. Treatment effects on COX-1, COX-2, Akt, NFκB and prostaglandin E₂ (PGE₂) synthesis were assessed following a 3- or 4-day culture period. Treatment with 3–4 μM γ-tocotrienol or 7.5–10 μM celecoxib alone significantly inhibited +SA cell growth in a dose-responsive manner. However, combined treatment with subeffective doses of γ-tocotrienol (0.25 μM) and celecoxib (2.5 μM) resulted in a synergistic antiproliferative effect, as determined by isobologram analysis, and this growth inhibitory effect was associated with a reduction in PGE₂ synthesis, and decrease in COX-2, phospho-Akt (active), and phospho-NFκB (active) levels. These results demonstrate that the synergistic anticancer effects of combined celecoxib and γ-tocotrienol therapy are mediated by COX-2 dependent and independent mechanisms. These findings also suggest that combination therapy with these agents may provide enhanced therapeutic response in breast cancer patients, while avoiding the toxicity associated with high-dose COX-2 inhibitor monotherapy.     

Diagnostic value of International Prostate Symptom Score voiding-to-storage subscore ratio in male lower urinary tract symptoms

Aims: To investigate the diagnostic value of the International Prostate Symptom Score (IPSS) voiding‐to‐storage subscore ratio (IPSS‐V/S) in male lower urinary tract symptoms (LUTS). Methods: A total of 253 men with LUTS were enrolled from January 2005 to July 2010. The voiding (IPSS‐V) and storage IPSS (IPSS‐S) subscores were recorded separately by the patients themselves. The IPSS‐V/S was calculated and compared among various aetiologies based on videourodynamic studies. Receiver operating characteristics (ROC) curves were constructed for comparing the diagnostic value of various non‐invasive methods for predicting failure to voiding and storage lower urinary tract dysfunction (LUTD). Results: Patients with failure to voiding LUTD, including benign prostatic obstruction (n = 72), bladder neck dysfunction (n = 19), urethral stricture (n = 3) and poor relaxation of the urethral sphincter (n = 32), had mean IPSS‐V/S scores > 1. In contrast, patients who were urodynamically normal (n = 2) or had failure to storage LUTD, including idiopathic detrusor overactivity (n = 84), increased bladder sensation (n = 37), and detrusor overactivity and impaired contractility (n = 4), had IPSS‐V/S scores ≤ 1. When IPSS‐V/S was used to differentiate male LUTS, failure to voiding LUTD was found in 81.2% of patients with IPSS scores > 1, while failure to storage LUTD was found in 75.7% of patients with IPSS‐V/S ≤ 1. The area under ROC curve of IPSS‐V/S was higher than for other non‐invasive methods for predicting failure to voiding and storage LUTD. Conclusion: Measuring IPSS subscores and calculating IPSS‐V/S is a simple and useful method to differentiate failure to voiding and failure to storage LUTD in men with LUTS. IPSS‐V/S may provide a guide for the initial treatment, especially for primary care physicians without access to urological studies.     

Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis

BACKGROUNDLung cancer is a major cause of death among patients, and non-small cell lung cancer (NSCLC) accounts for more than 80% of all lung cancers in many countries.AIMTo evaluate the clinical benefit (CB) of COX-2 inhibitors in patients with advanced NSCLC using systematic review.METHODSWe searched the six electronic databases up until December 9, 2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC. Overall survival (OS), progression free survival (PFS), 1-year survival rate (SR), overall response rate (ORR), CB, complete response (CR), partial response (PR), stable disease (SD), and toxicities were measured with more than one outcome as their endpoints. Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using Egger’s linear regression test. Data analysis was performed using R software.RESULTSThe COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS, progression free survival, 1-year SR, CB, CR, and SD. However, there was a difference in overall response rate for patients with advanced NSCLC. In a subgroup analysis, significantly increased ORR results were found for celecoxib, rofecoxib, first-line treatment, and PR. For adverse events, the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia, thrombocytopenia, and cardiovascular events.CONCLUSIONCOX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.     

体表电刺激治疗急性脑卒中后排尿障碍的临床观察

目的:观察体表电刺激(ES)治疗急性脑卒中后排尿障碍的临床效果,探讨排尿障碍治疗的新方法、新思路。方法:将95例急性脑卒中后排尿障碍患者按照治疗方法不同随机分为2组。常规治疗组采用常规留置或间歇清洁导尿、膀胱训练、药物治疗,共43例;ES组在常规治疗基础上加用耻骨上区、第2骶孔至第4骶孔体表投影区电刺激治疗,共52例。对两组患者进行治疗前后排尿日记、膀胱容量测定、生存质量(QOL)评分、国际下尿路综合征症状评分(LUTS),并观察比较其疗效。结果:治疗后两组患者的72h尿频次均低于治疗前(P<0.05),单次尿量均高于治疗前(P<0.05),且治疗后ES组72h尿频次较常规治疗组明显低(P<0.05),而单次尿量明显高于常规治疗组(P<0.01);治疗后,两组患者的膀胱容量均高于治疗前(P<0.05),残余尿量均明显低于治疗前(P<0.01)。且治疗后ES组膀胱容量高于常规治疗组(P<0.05),而残余尿量较常规治疗组明显低(P<0.05);治疗后两组患者的QOL评分、LUTS评分均低于治疗前(P<0.05,P<0.01),且治疗后ES治疗组QOL评分、LUTS评分均较常规治疗组低(P<0.05);ES治疗组中尿潴留患者治疗有效率为88.89%,明显高于常规治疗组(68.75%,P<0.05);ES治疗组中尿失禁患者治疗有效率为85.29%,明显高于常规治疗组(62.96%,P<0.05)。结论:对耻骨上区、第2骶孔至第4骶孔体表投影区行电刺激治疗急性脑卒中后排尿障碍疗效肯定,给临床治疗提供了一个无创、简单、方便、经济且无任何不良反应的方法,值得临床应用推广。     

Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

Acute urinary retention (AUR) is one of the most undesirable events for elderly men with benign prostatic hyperplasia (BPH). This study was designed to test the clinical utility of ultrasonic measurement of bladder weight as a predictor of AUR. A total number of 160 men visited our clinic with lower urinary tract symptoms (LUTS) suggestive of BPH and underwent urodynamic studies, including transrectal ultrasonography of the prostate and the measurement of ultrasound (US) estimated bladder weight (UEBW). Among them, 31 (19.4%) presented to our clinic with AUR. From the thickness of the anterior bladder wall measured by transabdominal ultrasonography and the intravesical volume, UEBW was calculated, supposing the bladder to be a sphere. Between patients with and without AUR, there were significant differences for age (75.4 vs. 71.1 years, p < 0.005), prostatic volume (45.5 vs. 35.8 g, p < 0.05), transition zone (TZ) volume (29.4 vs. 20.2 g, p < 0.05), TZ index (0.606 vs. 0.493, p < 0.005) and UEBW (50.3 vs. 34.7 g, p < 0.0001). A receiver-operating characteristic curve analysis demonstrated UEBW to be superior to the other prostatic ultrasonic measures in identifying AUR. Patients with LUTS suggestive of BPH having UEBW greater than 35.0 g were 13.4 times as likely to suffer from AUR. The significant association of UEBW with an increased risk of AUR suggests that it would be promising as a noninvasive urodynamic parameter capable of identifying patients at increased risk of AUR.     

功能性磁刺激治疗脊髓损伤患者神经源性膀胱

目的：观察功能性磁刺激(FMS)治疗脊髓损伤患者神经源性膀胱的疗效。方法：采用经S3神经根和膀胱区的FMS治疗脊髓损伤后神经源性膀胱患者12例，通过对患者尿流动力学的检查、因排尿症状而影响生活质量的生活质量评分和国际下尿路综合征(LUTS)症状评分进行疗效评价。结果：10例患者症状有显著改善，日平均排尿次数显著减少，日平均单次尿量增加，尿频、尿急、尿失禁的程度减轻，2例患者无效。结论：FMS可以显著地改善部分脊髓损伤后神经源性膀胱患者的膀胱功能并能显著提高患者的生活质量。     

电针膀胱经腧穴联合膀胱治疗仪治疗脊髓损伤后神经源性膀胱的临床疗效观察

目的：探讨电针膀胱经腧穴联合膀胱治疗仪治疗脊髓损伤（SCI）后神经源性膀胱（NB）的临床疗效及其对膀胱功能状态的影响。方法：选取42例SCI后NB患者，随机分为联合组和对照组，每组21例。对照组在基础治疗上采用膀胱治疗仪治疗，联合组在基础治疗上采用电针膀胱经腧穴联合膀胱治疗仪治疗。观察2组患者在治疗方案实施前、后排尿日记的指标：24h排尿次数、24h尿失禁次数、每次排尿量；尿流动力学指标：膀胱充盈逼尿肌压力、最大尿流率、最大尿道闭合压、残余尿量；LUTS评分，比较2组各项指标的变化。结果：治疗后，2组患者24 h 尿失禁次数、24 h排尿次数及尿流动力学观察指标逼尿肌压力、残余尿量分别较治疗方案实施前均减少，联合组减少更明显，排尿日记的观察指标每次排尿量及尿流动力学观察指标最大尿流率、最大尿道闭合压较治疗方案实施前均增大，联合组增大更明显，差异均具有统计学意义(P<0.05)。治疗后2组患者的 LUTS 评分较前均有明显减少(P<0.05)，且联合组更低于对照组(P<0.05)。结论：电针膀胱经腧穴联合膀胱治疗仪治疗SCI后 NB临床疗效较好，明显减少膀胱残余尿量，膀胱功能状态有效改善，生活质量得到提高，具有联合康复应用价值。     

尿动力学检查对糖尿病患者膀胱功能的评价

目的：探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断的意义。方法：对伴有下尿路症状的糖尿病患者34例，按糖尿病病史分为早期组（〈8a）与进展期组（〉10a），分别进行尿动力学测定，获取膀胱初始容量、最大膀胱容量、最大尿流率、残余尿、逼尿肌压力等参数作相关分析。结果：34例均完成尿动力学测定，尿动力学表现异常占30例（88．2％）；早期组与进展期组相比，最大尿流率明显下降（P〈0．01），初始尿意容量、残余尿、最大膀胱容量明显增高（P〈0．01），逼尿肌收缩力亦下降（P〈0．01）。结论：尿流动力学检查是对DCP进行客观评价的最重要的手段；早期的糖尿病患者予以治疗干预，对预防膀胱功能恶化有重要的意义。     

改良经闭孔无张力尿道中段悬吊带术联合经尿道膀胱颈内切术治疗女性压力性尿失禁合并膀胱颈梗阻的效果

目的分析改良经闭孔无张力尿道中段悬吊带术(TVT-O)联合经尿道膀胱颈内切术治疗女性压力性尿失禁合并膀胱颈梗阻的效果。方法将我院2015年3月至2020年3月收治的70例女性压力性尿失禁合并膀胱颈梗阻患者依照随机数字表法分为对照组(35例)与研究组(35例)。对照组给予传统TVT-O联合传统膀胱颈内切开术,研究组行改良TVT-O联合经尿道膀胱颈内切术治疗。比较两组患者的治疗效果。结果研究组手术时间、尿管留置时间、住院时间均短于对照组,术中出血量少于对照组(P<0.05)。研究组的并发症总发生率低于对照组,治疗总有效率高于对照组(P<0.05)。结论压力性尿失禁合并膀胱颈梗阻患者采用改良TVT-O联合经尿道膀胱颈内切术的效果确切,值得临床推广应用。     

膀胱功能训练对脊髓损伤患者尿路感染的影响

目的 探讨综合训练对脊髓损伤后膀胱功能障碍患者尿路感染的影响.方法 收集2006年1月-2008年6月脊髓损伤伴神经源性膀胱患者32例,采用留置导尿、Crede手法按摩、间歇性导尿术、电针刺激等综合训练及护理.训练期间定期查尿常规和中段尿培养.结果 通过对32例脊髓损伤患者2个月的膀胱功能综合训练,有30例患者训练后达到自主排尿,有2例患者膀胱功能未恢复,训练期间尿路感染率为6%,未发生肾功能衰竭.结论 脊髓损伤后膀胱功能障碍采取早期、规范、系统的综合训练,正确指导患者积极配合,能有效降低尿路感染,提高患者的生活质量.