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.     

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.     

间歇导尿技术联合膀胱功能锻炼在胸腰段骨折合并脊髓损伤神经源性膀胱患者中的应用

目的 探讨间歇导尿技术联合膀胱功能锻炼在胸腰段骨折合并脊髓损伤神经源性膀胱的应用效果,观察其对膀胱功能恢复及并发症的影响.方法 选取本院2017年1月～2020年1月收治的脊髓损伤合并NB患者63例,随机分为观察组32例和对照组31例.两组患者均在排尿前半小时进行膀胱功能锻炼,其中观察组采用间歇性导尿,对照组采用留置导...     

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。     

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.     

脊髓损伤后膀胱尿流动力学检查及分类

目的：检测脊髓损伤患者膀胱功能并分类。探讨并发症与膀胱功能的关系。方法：采用尿流动力学四导程测压仪对３６例脊髓损伤患者进行下尿路功能分组检测。结果：各组患者因脊髓损伤节段及程度的不同，会有不同的尿流动力学表现及不同的膀胱功能，而且有相应的并发症发生，这之间有一定的规律及内在联系，并据此将膀胱分为三类。结论：根据尿流动力学表现对脊髓损伤后膀胱进行分类，对临床有一定的指导意义。     

逼尿肌漏尿点压在神经原性排尿功能障碍上尿路损害评估中的意义

目的　探讨逼尿肌漏尿点压检测神经原性排尿功能障碍患者上尿路损害功能评估中的诊断价值。　方法　 38例神经原性排尿功能障碍患者行尿动力学检查 ,重点进行逼尿肌漏尿点压测定。　结果　以逼尿肌漏尿点压 4 .0kPa(1kPa=10 .2 0cmH2 O)为界将 38例患者分为高压 (n =2 6 )及低压 (n =12 )两组 ,高压组膀胱容量为 (42 2 .95± 183.2 7)ml,低压组为 (46 4 .83± 10 6 .4 3)ml,高压组逼尿肌顺应性较低压组低 ,逼尿肌尿道括约肌协同失调 (DSD)增高。B超、IVU、血尿素氮及血肌酐检查等临床指标检测显示逼尿肌漏尿点压高者上尿路损害机会较低压组显著增高。　结论　逼尿肌漏尿点压测定对神经原性排尿功能障碍患者上尿路损害状态的评估有较大价值。     

NGF与神经源性膀胱逼尿肌功能研究进展

随着NGF及其受体研究的深入,学者们发现NGF与膀胱功能有着密不可分的关系,NGF在膀胱疾病中的作用也越来越受到重视,研究发现膀胱组织能够在一些特定情况下增加NGF的表达,例如脊髓损伤、去神经化、炎症、膀胱过度活动等.NGF水平的变化会导致多种临床症状,如排尿功能紊乱、膀胱过度活动的产生及进展、膀胱疼痛(间质性膀胱炎)...     

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。     

神经移植术治疗截瘫神经性膀胱的尿动力学观察

目的　评价神经转位移植术治疗陈旧性截瘫神经性膀胱病人的手术效果。　方法　回顾性分析40例胸腰段骨折致截瘫神经性膀胱病人肋间血管神经转位桥接骶神经根35例、尺神经转位吻合阴部神经5例手术前后尿动力学检测结果。　结果　骶根组35例术前最大尿流率(Qmax)均低于正常,术后20例恢复正常（57%）,10例明显改善(28.6%),术前后逼尿肌最大收缩力分别为（60±15cmH     

脊髓损伤神经源性膀胱临床评估及治疗的研究进展

脊髓损伤患者经常合并有不同程度的神经源性膀胱症状,由此产生的各种泌尿系统并发症最终可能会导致肾功能衰竭,甚至死亡,不断的优化脊髓损伤神经源性膀胱患者的康复护理等治疗措施,对于提高患者生存质量,降低患者远期的死亡率,有重要的临床和社会意义。本文通过回顾文献,首先总结了神经源性膀胱在脊髓损伤不同阶段的表现,介绍了神经源性膀胱的临床评估,并详细概述了该类患者保守治疗,康复护理及手术治疗等措施,以便为此类患者的诊治提供参考。     

Comparison of extraperitoneal and intraperitoneal augmentation enterocystoplasty for neurogenic bladder in spinal cord injury patients

Objectives  Augmentation enterocystoplasty is the standard treatment for patients with neurogenic bladder who have failed medical management. Our “extraperitoneal” approach involves a small peritoneotomy to obtain the segment of bowel for augmentation, and a standard “clam” enterocystoplasty. We compared operative and postoperative parameters and clinical outcomes of this technique with the standard intraperitoneal technique. Methods  We retrospectively reviewed charts of 73 patients with neurogenic voiding dysfunction refractory to medical management who underwent augmentation enterocystoplasty alone or in conjunction with additional procedures. A total of 49 patients underwent extraperitoneal augmentation and 24 patients underwent intraperitoneal augmentation. Operative and postoperative parameters including time of surgery, estimated blood loss, need for blood transfusion, time for return of bowel function, and length of hospital stay were examined. Clinical outcomes including early and late postoperative complications, and continence status were also analyzed. Results  Median follow-up was 2.5 years. Patients in the extraperitoneal group had significantly shorter operative time (3.9 vs. 5.6 h, P < 0.0001); shorter hospital stay (8.0 vs. 10.5 days, P = 0.009); and shorter time to return of bowel function (3.5 vs. 4.9 days, P = 0.0005). There was no significant difference in complication rates. Postoperative continence was equally improved in both groups. When only patients with no prior abdominal surgery were compared, the findings were analogous: shorter operative time, shorter length of stay, sooner return of bowel function, and no difference in complication rate. Conclusions  The extraperitoneal technique provides an equally effective method of bladder augmentation to the standard technique with easier early postoperative recovery.     

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。     

膀胱壁内注射A型肉毒毒素治疗脊髓损伤患者神经原性膀胱的初步临床观察

目的：观察膀胱壁内注射A型肉毒毒素治疗脊髓损伤患者神经原性膀胱的临床效果。方法：78例脊髓损伤后神经原性膀胱患者，男59例，女19例，平均年龄38．9岁。将300单位A型肉毒毒素溶解于15ml生理盐水，使用膀胱镜注射针分30个点注射于膀胱壁，0．5ml／点。治疗前后均记录患者排尿日记，并观察药物毒副作用。结果：78例患者经第1次治疗后平均尿失禁次数由13．5次／d降至2．7次／d、平均导尿量由131ml／次增至389ml／次，平均尿失禁量由1690ml／d降至281ml／d，起效的平均时间为7．6d。10例患者在第1次注射8,9个月后接受第2次注射，平均尿失禁次数由9．7次/d降至3．7次/d，平均导尿量由108ml／次增至387ml／次。6例患者在第2次注射后5．8个月接受第3次注射，平均尿失禁次数由9．2次／d降至3．9次／d，平均导尿量由116ml／次增至364ml／次。随访期间未观察到任何毒副作用。结论：经尿道膀胱壁内A型肉毒毒素注射是治疗脊髓损伤患者神经原性膀胱的有效、安全、可多次重复应用的微创方法。     

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.     

An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury

Objectives

We aimed to investigate the relationship between the severity of the spinal lesion and urodynamic findings, bladder drainage method at discharge, and incidence of renal calculi in patients with spinal cord injury (SCI).

Studydesign

Retrospective.

Setting

In-patient rehabilitation unit of a tertiary research hospital.

Methods

A total of 131 patients who were admitted to our clinic with a diagnosis of SCI and placed into a rehabilitation program were included in the study. The severity of the lesion was determined according to the American Spinal Injury Association Impairment Scale (AIS). We evaluated the relationship between the severity of the lesion and the detrusor hyperactivity and compliance as determined by urodynamic investigation, the bladder drainage method used at discharge, and the renal calculi rate as determined by ultrasonography.

Results

While no difference was found between the patients with complete and incomplete injuries in terms of age, sex, disease duration, detrusor hyperactivity and compliance, the bladder drainage method was found to show a significant change according to the severity of the lesion. None of the patients were found to have hydronephrosis and the rate of renal calculi showed no statistically significant difference according to the severity of the lesion.

Conclusions

We concluded that urodynamic examination is required in each patient with SCI as the severity of the lesion is not sufficient to determine the bladder type, and patients with complete and incomplete injuries should be monitored with the same sensitivity in terms of complications.     

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat

Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.