神经原性膀胱膀胱扩大术后的长期尿动力学随访

神经原性膀胱患者保守治疗失败后，肠道膀胱扩大术是一种易被患者接受的术式，但是既往报道中没有长期随访的尿动力学结果。为此作者对此类患者进行了至少4年以上的随访。神经原性排尿功能障碍患者26例，或单纯行肠道膀胱扩大术．或同时进行不同类型的控尿及抗返流措施。临床随访内容包括尿失禁、用药情况、导尿日程表、后续干     

小儿正常和神经原性膀胱括约肌功能障碍尿动力学研究进展

小儿神经原性膀胱括约肌功能障碍(Neuropathic bladder—sphicter dysfunction，NBSD)多见，仅脊髓脊膜膨出(MMC)所引起的NBSD发病率为0．1%～0．2%，14％MMC患儿在5岁前死亡，总病死率可达50％。小儿NBSD的病因、下尿路解剖和功能特点以及治疗原则多不同于成人NBSD，如：①小儿NBSD伴有脊柱发育畸形和脊髓发育障碍；②小儿膀胱括约肌功能障碍会随着时间发生变化，在两个不同类型障碍阶段间无显著的界限；③正常小儿出生后开始几年，随着年龄的增长和发育成熟，逼尿肌和括约肌功能也在发生持续的变化；④目前缺乏小儿正常尿动力学参数，影响其准确诊断和有效治疗，尤其是在较小年龄组。最近，婴幼儿和儿童尿动力学检查技术的进步，使得我们可以更加准确地评估小儿NBSD，为其提供更新的病理生理认识，从而进行更科学有效的治疗。     

合并神经原性膀胱活动低下非瘫痪脊髓功能障碍患者生命质量评估和尿动力学研究

目的 探讨合并神经原性膀胱活动低下(NUB)非瘫痪脊髓功能障碍(NPSCD)患者肠道膀胱扩大术(ECP术)后生命质量评估和尿动力学参数改善情况.方法 采用SF-36问卷表对72例合并NUB的NPSCD患者进行生命质量评分,并依据尿动力学膀胱功能障碍类型行ECP术联合自我清洁间歇导尿(CISC)或单一CISC治疗,最终对完成1年生命质量评分和尿动力学检查的58例(81%)患者[男30例(平均27±5岁),女28例(平均26±4岁)]进行随访.选取40例无明显排尿异常症状正常志愿者[男20例(平均28±4岁)和女20例(平均29±4岁)]为对照组.结果 随访时,男女患者生理职能、生命力和社会功能得分分别为55±14和45±15、76±19和74±15、52±19和59±13,均显著高于治疗前35±10和32±11、27±18和33±17、40±12和34±15;最大膀胱压测定容量和膀胱顺应性分别为(320±44)和(338±50)ml、(55±15)和(60±17)cm H2O,显著高于治疗前的(131±30)和(140±35)ml、(5±3)和(6±4)cm H2O;逼尿肌漏尿点压分别为(6±2)和(6±3)cm H2O,显著低于治疗前的(28±9)和(25±6)cm H2O,治疗前后差异均有统计学意义(P＜0.05);但男女生理职能、总体健康、生命力、社会功能、情感职能和精神健康评分均显著低于对照组(P＜0.05);男女分别仅有17%和7%认为健康状况"比1年前稍好".合并反流性上尿路损害患者随访时男女上尿路情况分别有89%和76%出现不同程度改善. 结论合并NUB的NPSCD患者应用ECP术和CISC治疗尿动力学参数显著改善,但生命质量仍较低,迫切需要更有效地治疗方法.     

下尿路排尿功能障碍患者的影像尿动力学评估

目的:研究影像尿动力学检查在下尿路排尿功能障碍患者诊断和治疗中的价值。方法:应用影像尿动力学仪检查64例下尿路排尿功能障碍患者的排尿功能情况。结果:神经原性膀胱(Neurogenic bladder,NB)28例(43.75%),女性压力性尿失禁(Stress urinary incontinence,SUI)15例(23.43%),BPH 12例(18.75%),前列腺切除术(TURP)后排尿障碍4例(6.25%),女性排尿困难5例(7.82%)。发现膀胱输尿管反流5例,膀胱小梁或憩室25例,逼尿肌尿道括约肌协同失调8例,尿道远端狭窄1例。结论:影像尿动力学检查通过同时评估膀胱尿道的功能和形态,为复杂性下尿路排尿功能障碍性疾病的临床诊断和治疗提供可靠的依据。     

合并神经原性膀胱活动低下非瘫痪脊髓功能障碍患者生命质量评估和尿动力学研究

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation (CISC) in nonparalytic spinal cord dysfunction (NSCD) patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey (SF-36). Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58(81% ) patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men (mean age 27±5 year) and 28 women (mean age 26±4 year). The normal volunteers without lower urinary tract symptom were set as control group, including 20 men (mean age 28 ± 4 year) and 20 women (mean age 29±4 year). Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment (35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15). The bladder compliance and maximum cystometric capacity were (320 ± 44 ) ml and ( 338 ±50)ml,(55±15)cm H2O and (60±17)cm H2O respectively, also significantly higher than those before the treatment (131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O). However, detrusor leakage point pressures were (6±2)cm H2O and (6±3)cm H2O respectively, significantly lower than those before the treatment (28 ±9 cm H2 O and 25 ± 6 cm H2O). Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed "their health is better than that one year ago". There was no significant difference in the remission rate between men and women (89% vs 76%) in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC.     

合并神经原性膀胱活动低下非瘫痪脊髓功能障碍患者生命质量评估和尿动力学研究

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation (CISC) in nonparalytic spinal cord dysfunction (NSCD) patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey (SF-36). Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58(81% ) patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men (mean age 27±5 year) and 28 women (mean age 26±4 year). The normal volunteers without lower urinary tract symptom were set as control group, including 20 men (mean age 28 ± 4 year) and 20 women (mean age 29±4 year). Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment (35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15). The bladder compliance and maximum cystometric capacity were (320 ± 44 ) ml and ( 338 ±50)ml,(55±15)cm H2O and (60±17)cm H2O respectively, also significantly higher than those before the treatment (131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O). However, detrusor leakage point pressures were (6±2)cm H2O and (6±3)cm H2O respectively, significantly lower than those before the treatment (28 ±9 cm H2 O and 25 ± 6 cm H2O). Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed "their health is better than that one year ago". There was no significant difference in the remission rate between men and women (89% vs 76%) in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC.     

糖尿病性膀胱IPSS及影像或普通尿动力学研究

目的：评价糖尿病患者排尿异常与副尿肌行为间的关系。方法：对44例糖尿病患者进行影像或普通尿动力学检查及IPSS评价。将糖尿病性膀胱划分为逼尿肌受损型和感觉受损型。结果：17例糖尿病患者诊断为糖尿病性膀胱，27例糖尿病患者尿动力学结果正常。糖尿病性膀胱患者与尿动力学检查正常的糖尿病患者相比，尿流率中大多数参数差异具有显著性意义；主观症状评分梗阻指数显著性增高，但刺激症状指数差异无显著性意义。结论：梗阻指数升高而刺激指数无显著性升高可能是糖尿病性膀胱尿动力学的特征性改变。尽管尿流率和IPSS评价不能特异性区分逼尿肌受损情况，但为进一步进行尿动力学检查提供了有益的参考。     

犬神经原性膀胱模型的建立及尿动力学评价

目的　建立犬神经原性膀胱模型 ,进行尿动力学评价。　方法　 8只雌性杂交犬 ,骶上组 4只在第 5～ 6腰椎间孔水平横断脊髓 ,骶下组 4只在此基础上完全破坏骶髓。尿动力学测定模型犬术前及术后 6个月的膀胱容量、逼尿肌压力、膀胱顺应性、尿道压力。　结果　模型犬术后一直存在尾部不能活动和不同程度湿臀的现象 ;弛缓性瘫痪的后肢术后 1周起逐渐恢复 ;下腹部膨胀症状的改善仅见于骶上型犬。骶上组犬术后膀胱容量、顺应性分别下降 37.3%、5 2 .1% ,逼尿肌压力、尿道压力分别增加 33.3%、17.3% ,与术前相比差异均有显著性意义 (P <0 .0 5 ) ;骶下组犬的膀胱容量、顺应性分别上升 89.5 %、78.8% ,与术前和骶上组相比差异均有显著性意义 (P <0 .0 5 )。　结论　在症状及尿动力学方面 ,术后 6个月的犬骶上型和骶下型神经原性膀胱模型均符合脊髓损伤恢复期的膀胱表现 ,两模型适于进行神经原性膀胱的研究。     

神经源性膀胱尿道功能障碍患者的影像尿动力学研究

目的 探讨各类神经源性膀胱患者的影像尿动力学特点.方法 2002年12月至2008年6月间,我们对1800例神经源性膀胱患者进行了影像尿动力学检查,分析不同神经病变所致膀胱尿道功能障碍的影像学特点.结果 脑卒中患者均未发现上尿路改变和反流,71% 为逼尿肌过度活动(DO),60% 伴括约肌无抑制性松弛,29% 为逼尿肌无反射(DA).脑外伤患者中70% 为DO不伴协同失调.7例帕金森病患者均表现为DO.1170例骶上损伤患者91% 为DO,83% 伴逼尿肌括约肌协同失调(DSD),223例骶髓及以下损伤患者73% 为DA.共有12% 的创伤性脊髓损伤患者出现上尿路积水改变,4% 表现为膀胱输尿管反流.脊髓发育不良患者81% 表现为逼尿肌无反射,86% 膀胱顺应性下降,55% 有上尿路积水改变,31% 出现膀胱输尿管反流.腰椎间盘突出患者92% 为逼尿肌无反射,88% 膀胱顺应性基本正常.糖尿病膀胱患者81% 膀胱感觉减退,76% 排尿期逼尿肌收缩力低下.结论 不同神经病变所致神经源性膀胱尿道功能障碍的特点不同,应根据影像尿动力学检查结果 选择合适的临床治疗方案.     

儿童和青少年神经原性膀胱合并上尿路扩张的尿动力学特点分析

目的 探讨儿童和青少年神经原性膀胱合并上尿路扩张的尿动力学特点.方法 回顾性分析54例神经原性膀胱合并上尿路扩张患儿尿动力学检查资料,依据肾积水分级标准分为3组:Ⅰ组19例(Grignon 1级)、Ⅱ组18例(Grignon 2～3级)、Ⅲ组17例(Grignon 4～5级).51例无合并上尿路扩张神经原性膀胱患儿作为对照组.结果 上尿路扩张3组膀胱顺应性分别为(15.9±12.2)、(6.0±3.4)和(6.0±3.0)ml/cm H2O,显著低于对照组(27.9±19.7)ml/cm H2O;逼尿肌漏尿点压分别为(33±18)、(54±19)和(67±27)cm H2O,显著高于对照组(21±12)cm H2O;逼尿肌无收缩发生率分别为74%(14/19)、72%(13/18)和71%(12/17),显著高于对照组41%(21/51),差异均有统计学意义(P＜0.05);同时,Ⅱ和Ⅲ组膀胱顺应性显著低于Ⅰ组(P＜0.05),逼尿肌漏尿点压显著高于Ⅰ组(P＜0.05).存在逼尿肌主动收缩患儿中合并上尿路扩张最大逼尿肌收缩压(98±42)cm H2O,最大尿流率时逼尿肌压力(81±41)cm H2O,A/G比值60±41,均显著高于对照组[(67±19)cm H2O,(52±17)cm H2O,28±25,均为(P＜0.05)].尿动力学危险分数与神经原性膀胱上尿路形态呈正相关(rs=0.561).结论 选择应用尿动力学参数可以有效预测神经原性膀胱患儿发生上尿路扩张的可能性.     

Urodynamic study in the neurogenic bladder dysfunction caused by intervertebral disk hernia

AIMS: To discuss the clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia. METHODS: Thirty patients with neurogenic bladder dysfunction caused by intervertebral disk hernia were divided into three groups according to the category of detrusor muscle activity: neurogenic detrusor overactivity without detrusor sphincter dyssynergia (DSD), neurogenic detrusor overactivity with DSD, or detrusor underactivity. The patients were divided into three groups according to the condition of urinary retention and incontinence: urinary retention, urinary incontinence, or neither urinary retention nor urinary incontinence. Also they were divided into three groups according to the location of the intervertebral disk hernia: cervical hernia, thoracic hernia, or lumbar hernia. All patients underwent computer tomography (CT), magnetic resonance imaging (MRI), and urodynamic study. The results were analyzed statistically. RESULTS: There was significant correlation between the category of detrusor muscle activity, bladder compliance (BC, P < 0.05), and the pressure at maximum flow (P(det,Qmax), P < 0.01). There were significant differences in post void residual (PVR), cystometric capacity (CC), and maximum flow rate (Qmax) between the three groups of urinary retention, urinary incontinence, and the group of neither retention nor incontinence (P < 0.05). There was statistical correlation between the location of the intervertebral disk hernia and the urodynamic results. There was significant correlation between the BC (the threshold was 15 ml/cmH(2)O), detrusor pressure (Pdet, the threshold was 40 cmH(2)O), DSD, the location of intervertebral disk hernia, and the upper urinary tract lesion (P < 0.01). CONCLUSIONS: Urodynamic studies are indispensable in the classification, diagnosis, treatment, and prognosis of the neurogenic bladder dysfunction caused by intervertebral disk hernia.     

Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease

Objective: To provide an overview of clinical assessments and diagnostic tools, self-report measures (SRMs) and data sets used in neurogenic bladder and bowel (NBB) dysfunction and recommendations for their use with persons with spinal cord injury /disease (SCI/D).

Methods: Experts in SCI/D conducted literature reviews, compiled a list of NBB related assessments and measures, reviewed their psychometric properties, discussed their use in SCI/D and issued recommendations for the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) guidelines.

Results: Clinical assessments included 15 objective tests and diagnostic tools for neurogenic bladder and 12 for neurogenic bowel. Following a two-phase evaluation, eight SRMs were selected for final review with the Qualiveen and Short-Form (SF) Qualiveen and the Neurogenic Bowel Dysfunction Score (NBDS) being recommended as supplemental, highly-recommended due to their strong psychometrics and extensive use in SCI/D. Two datasets and other SRM measures were recommended as supplemental.

Conclusion: There is no one single measure that can be used to assess NBB dysfunction across all clinical research studies. Clinical and diagnostic tools are here recommended based on specific medical needs of the person with SCI/D. Following the CDE for SCI studies guidelines, we recommend both the SF-Qualiveen for bladder and the NBDS for bowel as relatively short measures with strong psychometrics. Other measures are also recommended. A combination of assessment tools (objective and subjective) to be used jointly across the spectrum of care seems critical to best capture changes related to NBB and develop better treatments.     

神经根刺激器在治疗脊髓损伤所致神经原性膀胱功能障碍的应用价值

【摘要】〓目的〓探讨神经根刺激器在治疗脊髓损伤所致神经原性膀胱功能障碍(NBD)的应用价值。方法〓选取2009年3月至2013年5月期间我院确诊治疗的脊髓损伤所致NBD患者72例,分刺激组和对照组,两组患者均给予每天2次口服托特罗定(2 mg/次)治疗,刺激组患者在此基础上给予神经根刺激治疗,其中刺激组依据治疗方法又分为骶神经电刺激(SNS)治疗组和神经肌肉电刺激(NES)治疗组,对所有患者进行为期3个月的随访,观察患者尿流动力学、尿道压力和日均排尿次数。结果〓在尿流动力学方面,NES组残余尿量和最大膀胱容量明显优于SNS组(P<0.017),而SNS组残余尿量与最大膀胱容量明显优于对照组(P<0.017);在逼尿肌压力水平与日均排尿次数方面,治疗后60 d,NES组明显优于对照组(P<0.017);治疗后120 d,NES组明显优于SNS组与对照组,SNS组明显优于对照组(P<0.017)。结论〓神经根刺激治疗有利于改善脊髓损伤所致NBD患者膀胱功能。     

脊髓发育不良和隐性骶椎裂致神经源性膀胱功能障碍的尿动力学表现

为了解脊髓发育不良和隐性骶椎裂对泌尿系统的影响，对３４例有泌尿系统症状的患者行尿动力学检查和辅助检查。结果显示有反射性膀胱２１例（６１．７％），其中逼尿肌外括约肌协同失调１３例，排尿困难为主要表现；逼尿肌外括约肌协同正常８例，急迫性尿失禁为主要表现。无反射性膀胱１３例（３８．５％），排尿困难、尿潴留为主要表现。１２例膀胱颈口开放患者９例有尿失禁，最大尿道闭合压为３．１７±１．４０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），２２例膀胱颈口闭合患者最大尿道闭合压为７．７７±３．５０ｋＰａ（Ｐ＜０．０１）。１５例ＩＶＵ显示有上尿路损害的患者排尿期膀胱压力为平均８．０１±４．３０ｋＰａ，１９例无上尿路损害的患者排尿期膀胱压力平均为３．０６±１．２０ｋＰａ，（Ｐ＜０．０１）。综合分析显示患者临床症状和尿动力学表现与脊髓损伤平面无对应关系。     

Urodynamic and physiologic patterns associated with the common causes of neurogenic bladder in adults

The clinical presentation of the neurogenic bladder can be as vast as the pathologic causes however urodynamics (UDS) can help guide clinical decision-making and help simplify a complex disease state. UDS may be considered as the gold standard in helping to break down complex and multifactorial voiding dysfunction into manageable goals; these include protecting the upper tracts, limiting urinary tract infections (UTI) via avoiding urinary stasis, and maintaining quality of life. Included within are examples of normal to pathologic tracings including normal filling and voiding, detrusor sphincteric coordination, changes in compliance, etc. Additionally we have provided expected UDS findings based on neurogenic disease process, including but not limited to, Parkinson’s, dementia, multiple sclerosis (MS) and spinal cord injury based on lesion location. Pattern recognition and understanding of UDS can help lead to quality of life improvements and optimal management for the patient with neurogenic bladder dysfunction.     

电刺激治疗神经源性膀胱感觉功能障碍的疗效观察

目的:观察电刺激治疗神经源性膀胱感觉功能障碍的疗效。方法:在2009年3月~2010年10月收治的神经源性膀胱患者中,选取以膀胱感觉功能障碍为主诉、经查体和尿动力学检查证实存在膀胱感觉功能障碍的患者38例,其中18例接受电刺激治疗(治疗组),男11例,女7例,年龄23~50岁,平均31.4岁,完全性脊髓损伤患者10例,不完全性脊髓损伤患者8例,病程1~32个月,平均7.2个月;其余20例不接受电刺激治疗,为对照组,男15例,女5例,年龄21~48岁,平均28.6岁,完全性脊髓损伤患者13例,不完全性脊髓损伤患者7例,病程1~27个月,平均6.9个月。尿动力学检查:治疗组中10例膀胱感觉消失,8例膀胱感觉减弱;对照组中11例膀胱感觉消失,9例膀胱感觉减弱。两组年龄、性别、膀胱感觉障碍类型相匹配。治疗组除常规训练外,每天先后进行膀胱腔内电刺激和经皮膀胱电刺激各1次;对照组只进行常规膀胱训练,不行电刺激治疗,1个月后比较两组患者膀胱感觉变化情况。结果:治疗组11例膀胱感觉获得不同程度改善,7例膀胱感觉无变化;8例膀胱感觉减弱患者平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为414±46ml、540±42ml,治疗后分别为255±41ml、420±82ml,治疗前后比较有显著性差异(P<0.05)。对照组治疗前后膀胱感觉无明显变化,平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为466±37ml、562±45ml,治疗后分别为421±21ml、598±47ml,治疗前后比较无显著性差异(P>0.05)。治疗前平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较无显著性差异(P>0.05),治疗后平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较有显著性差异(P<0.05)。结论:综合电刺激治疗能改善部分神经源性膀胱患者的膀胱感觉功能。     

膀胱自扩大术治疗高反射性神经原性膀胱

目的探讨膀胱自扩大手术治疗高反射性神经原性膀胱的方法及疗效。方法6例患者,男5例,女1例,年龄5～36岁,平均28岁。尿动力学检查显示6例均为膀胱反射亢进,逼尿肌括约肌协同失调。病程5～10年,平均6年。对6例患者的手术方法,手术前后膀胱容量,肾功能以及临床症状进行回顾分析。结果手术时间100～180min,平均120min。安全膀胱容量术前(182±52)ml,术后3个月(315±65)ml,术后10个月(420±105)ml,手术前后比较差异有统计学意义(P<0.01)。术后导尿间歇平均4h(3～5h),术前5例尿失禁患者尿失禁消失4例,1例经口服抗胆碱药物后症状明显改善。术前4例肾功能异常者3例恢复正常,1例改善。结论膀胱自扩大术结合清洁间歇自家导尿治疗高反射性小容量膀胱是一种简便,可靠的方法。     

Neuromodulation in neurogenic bladder

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction.     

Conservative treatment of neurogenic bladder dysfunction

Summary In neurogenic bladder dysfunction conservative treatment is preferred whenever possible and preservation of renal function remains the main topic. Additionally, a patient-related form of bladder management with decreased intravesical pressure and social dryness is needed. Therefore many strategies are available and after evaluation of the underlying neurogenic bladder dysfunction an individual kind of treatment can be used. Possible options are the clean intermittent catherization, anticholinergic drugs, detrusor triggering, electrical stimulation and bladder emptying by Valsalva's manouvre.      

Parkinsonism and neurogenic bladder

Summary In a group of patients suffering from Parkinson's disease, beside neurogenic bladder dysfunction, we have also found dysfunction affecting the external sphincter musculature. Treatment with L-Dopa probably improves the urethral symptoms by providing a relaxing effect on the urethral closure pressure together with better coordination of the pelvic floor and external sphincter Mechanism during micturition. The effect was parallel to the improvement in Parkinsonion symptoms. Experimental studies demonstrate the ability of L-Dopa to reduce urethral closure pressure and this effect was related to a central effect on the skeletal musculature.