托特罗定治疗特发性膀胱过度活动症

目的 观察新型毒蕈咸受体拮抗药托特罗定治疗特发性膀胱过度活动症的有效性和安全性。方法 将托特罗定1mg呼奥昔布宁5mg及安慰剂进行对比，疗程3周。夜间入睡前2h口服。结果 与安慰剂相比，托特罗定和奥昔布宁都使入睡前1h夜尿次数（P＜0．01）显减少。两处药物的副作用主要为口干。在口干（发生率和强度）方面，托特罗定要明显优于奥昔布宁（P＜0．05）。结论 托特罗定治疗特发性膀胱过度活动症效果明确，疗程3周即能达到疗效。尽管奥昔布宁也具有很好的疗效，但不良反应限制了它的应用。     

托特罗定联合盆底电刺激治疗女性膀胱过度活动症效果观察

目的观察托特罗定联合盆底神经电刺激治疗女性膀胱过度活动症的效果并探讨其作用机制。方法将2009年10月至2010年12月就诊的73例女性膀胱过度活动症患者随机分为两组：托特罗定组口服托特罗定2mg／次,2次／d,疗程4周;联合治疗组口服托特罗定2mg／次,20：／d,加用盆底神经电刺激治疗,隔日1次,疗程4周。结果与治疗前比较,两组患者的膀胱过度活动症状（尿急、急迫性尿失禁、排尿次数、每次排尿量）减轻（P均〈0．05）。两组之间比较,在减轻尿急次数、尿失禁次数及夜尿次数指标上,两组差异无统计学意义（P均〉0．05）,但联合治疗组在减少每日排尿次数[（5．6±0．1）次]及每次排尿量[（248±14．6）ml]的增加方面优于托特罗定组[（7．6±0．3）次、（207±11．3）ml],差异有统计学意义（P均〈0．05）。结论托特罗定联合盆底神经电刺激能明显改善女性OAB症状,提高患者生活质量,疗效优于单用托特罗定,有一定临床意义。     

托特罗定治疗特发性膀胱过度活动症

目的观察新型毒蕈咸受体拮抗药托特罗定治疗特发性膀胱过度活动症的有效性和安全性。方法将托特罗定1mg呼奥昔布宁5mg及安慰剂进行对比,疗程3周。夜间入睡前2h口服。结果与安慰剂相比,托特罗定和奥昔布宁都使入睡前1h夜尿次数(P<0.01)显著减少。两种药物的副作用主要为口干。在口干(发生率和强度)方面,托特罗定要明显优于奥昔布宁(P<0.05)。结论托特罗定治疗特发性膀胱过度活动症效果明确,疗程3周即能达到疗效。尽管奥昔布宁也具有很好的疗效,但不良反应限制了它的应用。     

加倍剂量酒石酸托特罗定治疗脊髓损伤致逼尿肌过度活动的效果观察

目的观察加倍剂量酒石酸托特罗定治疗脊髓损伤所致膀胱过度活动的临床效果。方法采用自身对临床试验对30例患有膀胱过度活动症的脊髓损伤患者且使用酒石酸托特罗定2 mg/次,每日两次治疗,4周后效果不佳者,加倍剂量(4 mg, 每日两次)进行治疗,以排尿日记和生活质量评分观察其治疗的效果。主观感受评价采用国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)。结果4周后30例患者有28例完成试验,2例患者因口干不能耐受退出。28例患者使用加倍剂量酒石酸托特罗定治疗后每次导尿量由(196.3±44.7) ml增加到(393.5±54.3) ml。漏尿次数由每天(4.96±2.15)次减少到(3.92±2.14)次。ICI-Q-SF评价显示,治疗后改善25例,无效3例。结论脊髓损伤导致的膀胱过度症在可耐受口干的条件下酒石酸托特罗定加倍剂量可有效增加膀胱容量,减少漏尿次数。     

电刺激联合生物反馈治疗女性膀胱不稳定尿失禁的临床疗效评价

目的探讨电刺激联合生物反馈治疗对女性急迫性尿失禁的疗效。方法选取广州医科大学附属第三医院盆底诊治中心诊断为急迫性尿失禁的女性患者80例,将其随机分为盆底治疗组和药物组。盆底治疗组采用电刺激联合生物反馈治疗,每次治疗30 min,每周2次,10次为1个疗程。药物组采用口服药物(托特罗定)治疗,2 mg/次,一日2次,剂量及用药时间随患者症状进行调整。治疗2个疗程后对两组患者进行评估,评估内容包括:临床评估(体征、残余尿、排尿日记和辅助检查)、尿失禁问卷简表(ICIQ-SF)、尿动力学检查等。收集以上数据采用SPSS 19.0统计软件进行统计分析,P<0.05认为差异有统计学意义。结果采用秩检验比较盆底治疗组和药物组间的症状缓解情况,未发现统计差异(U=0.25,P=0.8)。采用配对样本的t检验比较两组在临床评估、ICIQ-SF评分和尿动力学等指标治疗前后的差异,均存在统计学差异(P<0.001),且两组指标在治疗前后的变化趋势一致;其中24 h排尿量(TV)、最大膀胱容量(CBC)及膀胱顺应性(BC)较治疗前明显增加,其余指标[24 h排尿量(TV)、24 h尿失禁次数(LT)、ICIQ-SF评分、最大尿道闭合压(MUCP)及最大逼尿肌压力(Pdet-max)]均较治疗前呈不同程度的减少。结论电刺激联合生物反馈治疗女性急迫性尿失禁临床应用效果好。     

行为疗法在女性膀胱过度活动症患者护理中的应用

目的探讨行为疗法在女性膀胱过度活动症（0AB）患者护理中的应用效果。方法24例OAB患者进行行为疗法即膀胱训练、盆底肌训练、排尿中断训练。结果24例OAB患者单次尿量均较训练前增加,20例患者可达300±17．82ml,平均单次尿量261．81±3．41ml。排尿间隔2～4h。结论行为疗法在女性OAB患者护理中效果确定,简便易行,不增加患者费用,宜于临床应用。     

行为疗法在膀胱过度活动症中的应用进展

膀胱过度活动症(OAB)因其严重影响生活质量,目前已经成为全世界严重的社会健康问题之一[1]。国际尿控协会(ICS)将OAB定义为尿急伴或不伴急迫性尿失禁(UI),通常有尿频和夜尿增多,而无泌尿系统感染或其他确切病变者[2]。行为疗法是建立在行为学习理论基础上的一种治疗方法,其     

盆底磁刺激联合针灸治疗膀胱过度活动症的疗效观察

目的 观察盆底磁刺激联合针灸治疗膀胱过度活动症(OAB)的临床疗效。 方法 采用随机数字表法将60例OAB患者分为对照组及观察组,每组30例。对照组患者给予琥珀酸索利那新片口服,每天口服1次,连续服用2周;观察组患者给予盆底磁刺激及针灸治疗,每天治疗1次,每周治疗5 d,连续治疗2周。于入选时、治疗后2周、1个月、3个月及6个月时分别采用膀胱过度活动症评分量表（OABSS）、国际尿失禁咨询问卷-膀胱过度活动症分问卷（ICIQ-OAB）对2组患者进行疗效评估。 结果 治疗后2周、1个月、3个月及6个月时2组患者OABSS评分、ICIQ-OAB评分均较治疗前显著降低（均P＜0.05）,并且治疗后1个月、3个月及6个月时观察组OABSS评分、ICIQ-OAB评分亦较治疗后2周时进一步降低（均P＜0.05）。经组间比较发现,治疗后2周、1个月、3个月及6个月时观察组OABSS评分、ICIQ-OAB评分亦显著低于同期对照组水平（均P＜0.05）。 结论 盆底磁刺激联合针灸治疗OAB的近期及远期疗效均显著优于常规药物治疗,能进一步减轻患者尿失禁症状,有效改善患者生活质量。     

膀胱过度活动症治疗进展

膀胱过度活动症(overactive bladder,OAB)是一种临床上常见的以尿急症状为特征的症候群,常伴有尿频和夜尿症状,可伴或不伴急迫性尿失禁,可明显影响患者的日常生活和社会活动。随着对下尿路功能的深入研究,该病在临床治疗方面也取得了较快的发展。下面将对膀胱过度活动症的治疗方面作一简要综述。     

行为疗法联合药物治疗经尿道前列腺电切术后膀胱过度活动症的疗效分析

目的 探讨行为疗法联合药物治疗尿道前列腺电切术后膀胱过度活动症的疗效。方法 选取120例TURP术后OAB患者,随机分为对照组(药物治疗组)、实验组(行为疗法组)和联合治疗组(行为疗法联合药物治疗组),每组40例,观察各组拔管后第7、14、28天的OABSS评分及排尿情况,观察服药期间的不良反应。结果 联合治疗组在拔除尿管后第7、14、28天的OABSS评分、24h尿急次数、24h排尿次数、夜尿次数、急迫性尿失禁次数均低于药物治疗组和行为疗法组,差异有统计学意义(P＜0.01)。药物治疗组及行为疗法联合药物治疗组服药期间药物不良反应发生率分别为11.25%,但未发生严重不良反应,患者均可耐受。结论 行为疗法联合药物治疗能更有效改善TURP术后患者OAB症状,可于TURP术后早期应用。     

Symptom-specific efficacy of tolterodine extended release in patients with overactive bladder: the IMPACT trial

We evaluated the efficacy of tolterodine extended release (ER) for patients' most bothersome overactive bladder (OAB) symptom in a primary care setting. Patients with OAB symptoms for >or=3 months received tolterodine ER (4 mg q.d.) for 12 weeks. Among incontinent patients (n = 772), the most bothersome OAB symptoms were daytime frequency (28%), urgency urinary incontinence (UUI; 27%), nocturnal frequency (26%) and urgency (19%); among continent patients (n = 91), they were daytime frequency (47%), nocturnal frequency (42%) and urgency (10%). Sixty-nine per cent of patients had one or more comorbid conditions. By week 12, there were significant reductions in patients' most bothersome symptom: -80% for UUI, -78% for urgency episodes, -40% for nocturnal frequency and -30% for daytime frequency (p < 0.0001). The most common adverse events were dry mouth (10%) and constipation (4%). In primary care practice, bothersome OAB symptoms can be effectively and safely treated with tolterodine ER, even in patients with comorbid conditions.     

Bacteriuria is associated with urge urinary incontinence in older women

Objective

To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men.

Design

Cross-sectional study.

Setting

The catchment area of a primary healthcare centre in a Swedish middle-sized town.

Subjects

Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537).

Main outcome measures

Urinary cultures and questionnaire data on urinary incontinence.

Results

In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35–5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49–7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence.

Conclusion

Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.     

行为疗法治疗女性轻中度压力性尿失禁的疗效观察

[目的]观察行为疗法治疗女性轻、中度压力性尿失禁的效果.[方法]选择31例女性压力性尿失禁病人,进行行为训练,包括盆底肌锻炼、尿急训练、膀胱功能训练、生活方式干预.治疗观察12周,评价其疗效.[结果]轻度组总有效率91.3%,中度组总有效率62.5%.[结论]行为疗法对女性轻、中度压力性尿失禁治疗效果满意.     

Persistence with antimuscarinic therapy in patients with overactive bladder

Overactive bladder (OAB) is a chronic condition, which impacts patients' health and quality of life. The primary symptoms of OAB are distressing and may interfere with work, psychosocial and sexual functioning. OAB also is associated with increased risk of urinary tract infections, fractures from falls, skin infections and depression. Patient's concerns about the effects of incontinence on lifestyle highlight the need to restore continence. The mainstay of treatment is antimuscarinic drug therapy, which may often produce only modest reductions in OAB symptoms and may be accompanied by bothersome adverse effects, leading to poor adherence to prescribed medications. Successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improve symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with therapy during long-term therapy.     

Darifenacin in the treatment of overactive bladder

Antimuscarinic drug therapy has been shown to be effective in the management of patients with symptoms of the overactive bladder syndrome (OAB), but the bothersome antimuscarinic adverse effects of dry mouth, constipation, somnolence and blurred vision often affect compliance with medication. The development of bladder selective M3 specific antagonists offers the possibility of increasing efficacy whilst minimising adverse effects. The M3 specific antagonist solifenacin has recently been marketed, and darifenacin will soon be available. The purpose of this article is to review the pharmacology and clinical trial data available for darifenacin, in addition to examining its role in the treatment of the OBS.     

生物反馈治疗联合康复训练在中年女性膀胱过度活动症患者中的应用效果

目的 探讨生物反馈治疗联合康复训练在中年女性膀胱过度活动症(OAB)患者中的应用效果.方法 选取医院2015年2月—2017年8月收治的中年女性OAB患者96例为研究对象,将患者按照组间年龄、病程、膀胱过度活动症患者症状评估表(OABSS)评分匹配的原则分为对照组和观察组,每组48例.对照组采取常规护理及药物治疗,观察...     

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。     

盆底肌锻炼联合膀胱训练治疗前列腺癌根治术后尿失禁的疗效观察

目的:探讨盆底肌锻炼联合膀胱训练对前列腺癌根治术后尿失禁的治疗效果。方法:回顾分析我院8例前列腺癌根治术后出现尿失禁的患者采用盆底肌锻炼联合膀胱训练的治疗措施后患者控尿能力改变的情况。结果:治疗后LT、ICI-Q-SF1及1小时尿垫试验显著低于治疗前(P0.05),而PVLP和PMUC显著高于治疗前(P0.05)。8例术后不同程度尿失禁患者,治愈5例(62.5%),有效2例(25.0%),无效1例(12.5%)。术后控尿总有效率为87.5%。结论:盆底肌联合膀胱训练的综合康复锻炼在治疗前列腺癌根治术后尿失禁的控制方面有良好的效果,是一种相对无损伤、简便、安全、有效的治疗方法。     

Validation of an overactive bladder awareness tool for use in primary care settings

Overactive bladder (OAB)—a syndrome characterized by urinary urgency, with or without urge incontinence, urinary frequency and nocturia—is estimated to affect 10% to 20% of the US and European populations. This study was carried out to validate a patient-administered screening awareness tool to identify patients with bothersome OAB symptoms. Patients were recruited from 12 primary care and 1 gynecology practice during regularly scheduled appointments. Enrollees completed an 8-item questionnaire assessing the amount of “bother” they associated with OAB symptoms. Clinicians then asked the patients 4 questions regarding urinary frequency, urgency, nocturia, and incontinence. If the screening was positive for symptoms of OAB or if the patient provided positive responses to the urinary symptom questions, the clinician asked additional questions regarding lifestyle and coping behaviors. The clinician then diagnosed the patient, placing him or her in the “No OAB,” “Possible OAB,” or “Probable OAB” category. Multivariable logistic regressions controlling for age and sex were performed to assess the applicability of the tool for identifying patients with OAB. A total of 1299 patients were enrolled, and 1260 provided complete data. Patients were aged 51.6±17.0 years, 62% were female, most (89%) were Caucasian, 22% experienced urinary urgency, and 18% experienced urge incontinence. The prevalence of Probable OAB was 12%. The c-index of the model identifying patients with a diagnosis of Probable OAB was 0.96, with a sensitivity and specificity of 98.0 and 82.7. For OAB-V8 scores ≥8, the odds ratio for Probable OAB was 95.7 (95% Cl: 29.3; 312.4). The OAB-V8 performed well in helping clinicians identify patients with bothersome OAB symptoms in a primary care setting and will assist clinicians in identifying patients who may benefit from treatment.