电针疗法治疗膀胱过度活动症的临床研究

目的:为了提高膀胱过度活动症的临床疗效,改善患者的生活质量,并通过尿动力学检查为选择后续治疗方式提供帮助,进行了本研究。方法:将纳入病人随机分为西药组和电针组,西药组(n=60):口服托特罗定2mg,Bid;电针组(n=60):在西药组治疗基础上采用电针疗法,取穴:双侧肾俞穴、双侧会阳穴、次髎、三阴交,每日1次30min,6次后休息1d,2周为1个疗程,共3个月。3个月后观察相应的疗效指标。结果:通过观察,电针组在改善排尿频率、最大膀胱压测定容量、强烈排尿感容量等方面明显优于西药组。结论:电针治疗膀胱过度活动症的临床疗效显著,操作简便,无不良反应及术后并发症,优于西医西药,值得广泛推广。     

膀胱过度活动症评估工具的研究进展

通过对膀胱过度活动症评估工具的信效度、特征、适用范围等方面的阐述,综述了国外膀胱过度活动症评估工具的研究进展,为国内的相关研究提供参考。     

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     

膀胱过度活动症的圆桌会议纪要

膀胱过度活动症（overactive bladder，OAB）是近年来神经泌尿学领域的一个研究热点。OAB是一种以尿急症状为特征的征候群，常伴有尿频和夜尿症状，伴或不伴急迫性尿失禁；尿动力学上可表现为逼尿肌过度活动，也可为其他形式的尿道-膀胱功能障碍。在最近召开的一次关于OAB的国际圆桌会议上，多位专家针对OAB进行了详尽讨论。     

膀胱过度活动症的诊治

进修医生教授,首先请您谈谈膀胱过度活动症的一些基本情况好吗? 教授膀胱过度活动症(overactive bladder,OAB)是一种以尿急症状为特征的综合征,常伴有尿频和夜尿症状,可伴或不伴有急迫性尿失禁.OAB是一种以症状学诊断为基础的概念,它取代了以尿动力学诊断为基础的逼尿肌过度活动这一概念.OAB在尿动力学上既可表现为逼尿肌过度活动,也可表现为其他形式的尿道-膀胱功能障碍.OAB无明确的病因,它不包括由急性尿路感染或其他形式的膀胱尿道局部病变所致的尿频、尿急症状,可把它与伴有OAB症状的其它许多疾病区分开来.OAB与下尿路综合征(lower urinary tract symptoms,LUTS)的鉴别点在于:OAB仅包含有储尿期症状,而LUTS既包括储尿期症状,也包括排尿期症状,如排尿困难等.     

膀胱过度活动症的研究进展

膀胱过度活动症是一种新的疾病诊断概念,表现为尿频、尿急,或合并急迫性尿失禁,是相当常见的慢性疾患,可严重困扰患者的生活。现对膀胱过度活动症的病因、诊断和治疗等进展作一综述。     

女性膀胱过度活动症之辨证论治

膀胱过度活动症(OAB)是一种以尿急症状为特征的征候群,常伴有尿频和夜尿症状,可伴或不伴有急迫性尿失禁。尿动力学上可表现为逼尿肌过度活动,也可为其他形式的尿道———膀胱功能障碍。〔1〕女性OAB多发生于中年已婚患者,发作突然,周期性发作,不包括由急性尿路感染或其他形式的     

膀胱过度活动症(OAB)治疗近况

膀胱过度活动症(overactive bladder，OAB)是常规的排尿功能障碍的临床症状，也是目前国内外研究的热点之一。OAB的异名很多，但有神经异常原因者，常称逼尿肌反射亢进(detrusor hyperflexia)。根据国际尿控协会将OAB定义为逼尿肌无意识收缩，前提是没有感染或其他明显的病理改变，表现为尿急，伴有／也可不会急迫性尿失禁，并且经常有尿频和夜尿症状。     

膀胱过度活动症及其研究进展

根据国际尿控协会（ICS）最新定义,下尿路症状（lower urinary tract symptoms,LUTS）被分为储尿期、排尿期和排尿后症状。储尿期症状是指膀胱储尿期所产生的症状,包括尿急、尿频、夜尿、急迫性尿失禁等。为了突出储尿期症状,膀胱过度活动症（OAB）的概念被提出,并正引起当今泌尿外科的重视。ICS于2002年对OAB正式定义：OAB是一种提示下尿路功能障碍的症状综合征,     

针灸及护理干预治疗女性膀胱过度活动症的临床研究

目的 针灸及护理干预治疗女性膀胱过度活动症疗效观察.方法 选择女性膀胱过度活动症患者60例,随机分为对照组和观察组各30例.对照组采用行为干预护理;观察组在与对照组相同的行为干预护理基础上配合针灸治疗,一个疗程(5周)后观察记录两组患者排尿症状和储尿期的单次尿量及膀胱最大容量及尿动力学结果的评估.结果 观察组治疗后在尿频、尿急、夜尿和尿失禁的发生率均少于对照组;观察组治疗后储尿期的单次尿量及膀胱最大容量的改善高于对照组;观察组治疗后尿动力学结果逼尿肌不稳定型的例数少于对照组,差异均有显著意义(P＜0.05).结论 针灸及护理干预治疗女性膀胱过度活动症,能有效改善临床症状.     

感觉相关的排尿日记在社区女性膀胱过度活动症中的应用研究

目的 应用感觉相关的排尿日记评价40岁及以上的社区女性的膀胱过度活动症(OAB)发病情况.方法 620例女性(平均58岁)完成了3 d的感觉相关的排尿日记.膀胱感觉的定义:0级=膀胱没有感觉,1级=膀胱有涨满的感觉,但没有排尿的愿望,2级=有排尿愿望,3级=有强烈的排尿愿望,4级=有非常紧迫的排尿愿望,但没有急迫性尿失禁,5级=出现因尿急引起的漏尿.结果 96例(15.5%)有OAB症状,包括74例(11.9%)没有急迫性尿失禁(即干性OAB)和22例(3.5%)伴有急迫性尿失禁(即湿性OAB).在全部的11 418次排尿中,随着膀胱感觉等级的增加,排尿量显著增加.干性OAB受试者的24 h排尿量显著高于正常受试者.湿性OAB受试者的平均排尿量显著低于干性OAB受试者和正常受试者.无尿急感觉的正常组的膀胱感觉3级时平均排尿量显著高于其他各组.湿性OAB组的膀胱感觉4级和5级时排尿量显著低于正常组和干性OAB组.结论 感觉相关的排尿日记能有效地评价排尿感觉、尿失禁和排尿模式.正常组、干性OAB组和湿性OAB组中引起诸如尿急或尿频等症状的原因可能不同.     

Solifenacin significantly improves all symptoms of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a chronic condition characterised by urgency, with or without associated urge incontinence. Solifenacin succinate is a once daily, bladder selective antimuscarinic available in two doses (5 and 10 mg). The recommended dose is 5 mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. This article presents pooled efficacy and safety data from four large, placebo-controlled, multinational phase III trials of solifenacin succinate with a total enrolment of over 2800 patients. Data from these trials show that solifenacin 5 and 10 mg once daily is significantly more effective than placebo at reducing urgency, incontinence, micturition frequency and nocturia and at increasing volume voided per micturition. Adverse events were mainly mild-to-moderate in all treatment groups. The results of these phase III trials support the use of solifenacin in the treatment of OAB.     

膀胱过度活动症对跌倒发生的影响——一项针对社区40岁以上妇女的研究

目的针对市区及乡镇40岁以上女性,评估膀胱过度活动症对跌倒发生及对跌倒关注度(或对跌倒焦虑心理)的影响。方法采用基于人群的队列研究方法,用KHQ问卷(KHQ),国际跌倒效能量表(自评跌倒风险量表、自评跌倒关注程度量表)和一份跌倒相关问卷,调查对象为广东省深圳市40岁以上女性。514位应答者的数据用于分析。膀胱过度活动症被定义为在KHQ问卷(KHQ)中回答"中等"或"很多"尿急或急性尿失禁者。跌倒发生被定义为去年有过跌倒经历。高度跌倒恐惧定义为国际跌倒效能量表(FES-I)评分在24分或以上者。统计方法为χ2检验及t检验。多元回归分析用于检查膀胱过度活动症对跌倒及对跌倒关注度(或对跌倒焦虑心理)的影响。结果 514例应答者中,98例符合膀胱过度活动症诊断。89例(17.3%)去年有过跌倒:27例(27.5%)患有膀胱过度活动症,62例(14.9%)无膀胱过度活动症。跌倒和膀胱过度活动症呈显著相关[比值比(OR)=1.76;95%可信区间(CI)为1.00～3.08;P=0.048],跌倒恐惧心理和膀胱过度活动症显著相关(OR=2.72;95%CI为1.42～5.20;P=0.002)。结论尿急与急性尿失禁症状会增加40岁以上妇女发生跌倒的风险。早期诊断及适当治疗可以预防跌倒发生,提高膀胱过度活动症患者的生活质量。     

Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial

BackgroundOveractive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder.ObjectiveTo investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life.DesignThe study was a parallel, pragmatic, open-label randomized trial.SettingsThe trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China.ParticipantsA total of 104 patients were randomly assigned to a 6-week education program or a control group.MethodsPrimary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models.ResultsCompared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (−0.7, p < 0.001), place preference for voiding (−0.5, p = 0.007), and delayed voiding (−0.2, p = 0.011). The program significantly relieved the bladder symptoms (−2.2, p < 0.001) and decreased the probability of having wet overactive bladder (−0.3, p < 0.001) and the severity of urgency (−0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients’ general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed.ConclusionsAmong overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.     

Intradetrusor onabotulinumtoxinA for overactive bladder

Introduction: Overactive bladder is a life-compromising disease that affects approximately 11.8% of all men and women, with increasing rates in the elderly. The mainstay of pharmacotherapy for this disease, anticholinergics, has up to a 71% discontinuation rate at 6 months. The emerging data of intradetrusor onabotulinumtoxinA (onabotA) use for treatment of idiopathic overactive bladder is showing to be an efficacious and well-tolerated alternative to the mainstay of therapy.

Areas covered: This study covers the use of onabotA and its use for idiopathic overactive bladder, stemming from its use in neurogenic detrusor overactivity, by evaluating the conclusions of current studies. A literature search and review was carried out for onabotA in treatment of overactive bladder using PubMed.

Expert opinion: Multiple randomized clinical trials have shown that intradetrusor injection with onabotA is effective in treating non-neurogenic bladder with promising efficacy in patients who have failed traditional pharmacotherapy. This treatment may be superior in certain patients due to its higher rate of compliance and higher rates of complete symptom resolution. Long-term studies are needed.     

Consideration of pelvic floor myofascial release for overactive bladder

IntroductionPhysical therapy has been shown to be effective for women with overactive bladder (OAB). We report on our experience with pelvic floor physical therapy (PFPT) with or without myofascial release as treatment for women with symptoms of urinary urgency or urge incontinence.MethodsWe performed a retrospective chart review, of patients who presented to our tertiary care Urogynecology practice. These women were evaluated and treated between August 2016 and December 2016. We abstracted for symptoms as per history of present illness and the pelvic floor muscle examination. PFPT progress notes were reviewed to determine whether patients received myofascial release techniques, or if therapy was limited to behavioral interventions and urge suppression techniques. We recorded the number of PFPT sessions attended, and whether the patient reported improvement.Results77 patients with symptoms of OAB met inclusion criteria and initiated PFPT. Myofascial tenderness of the pelvic floor muscles was found in 56.5% of patients. PFPT was limited to behavioral and urge suppression in 18 patients, while 59 patients received myofascial release techniques. Improvement was reported by 71.4% (n = 55/77) of patients. Improvement increased with number of sessions attended: 1–2: 6% (1/17), 3–5: 94% (16/17), 6–8: 91% (29/32), and >8: 80% (9/11) improved, respectively (p < 0.001). Among patients who had myofascial release, 84.7% reported improvement when compared to only 27.8% of patients without myofascial release.ConclusionsThe data support the inclusion of myofascial release during pelvic floor physical therapy for overactive bladder. At least three sessions of PFPT are necessary for patient reported improvement.     

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。     

Health‐related quality of life in people with overactive bladder symptoms: reliability and validity of the traditional Chinese version of the Kings' Health Questionnaire

Overactive bladder (OAB) is a common medical condition. A number of health‐related quality of life (HRQOL) measurements for OAB have been developed during recent years, including the linguistic validation of the traditional Chinese version of the Kings' Health Questionnaire (KHQ). However, limited studies are available for this version of KHQ. Hence, the aim of this study was to examine the reliability and discriminant validity of this traditional Chinese version within the communities of Taiwanese. A cross‐sectional and case–control study was designed. On the basis of a convenience sampling, participants were recruited at a community health center in Pingtung County, Taiwan from March to July 2010. The collected data included OAB symptoms assessed by the Overactive Bladder Symptom Score (OABSS), the HRQOL assessed by the traditional Chinese version of the KHQ and demographic characteristics. Subjects with urinary urgency at least once a week and a total score of OABSS ≥ 3 were assigned to the OAB group. Participants without OAB but with matched age and gender were selected as the control group. Internal consistency reliability was assessed using Cronbach's α, and discriminant validity was examined by Student's independent t‐test. A total of 173 pairs of observations were matched and analysed. The Cronbach's α value was above 0·80 for the traditional Chinese version of KHQ and all its subscales, suggesting a good internal consistency reliability for this measurement. The participants in OAB group showed poor quality of life than the controls (all p < 0·001), which display a good discriminant validity of traditional Chinese version of KHQ. Only 39·9% (n = 69) participants with OAB had discussed their symptoms with a doctor during the past year. As the HRQOL could be improved by medical help, health care providers should educate the public about OAB and encourage patients to seek medical attention.     

骨盆底肌电刺激治疗膀胱过度活动症

目的　探讨骨盆底肌电刺激治疗膀胱过度活动症 (OAB)的效果。方法　对经过临床症状及排尿动力学检查确诊的 4 0例OAB患者随机分为电刺激治疗组 (2 0例 )及药物治疗组 (2 0例 )。电刺激治疗组 :采用美国LABORIE公司生产的盆腔生物反馈电刺激治疗仪 ,通过阴道或直肠电极 ,对患者进行阴道或直肠内 10～ 2 0次 8～ 70mA的电刺激治疗 ;药物治疗组 :舍尼亭 (酒石酸托特罗定片 ) 2mg口服 ,2次 /d ,共 2周。通过排尿日记、副作用及满意度调查表来评价疗效。结果　电刺激治疗组治愈率为 6 0 % ,总有效率 85 % ,满意率 70 % ;药物治疗组治愈率为 5 0 % ,总有效率 80 % ,满意率 6 5 % ,两组疗效及满意率经Ridit分析无统计学差异 (P >0 .0 5 ) ;两组治疗副作用比较有统计学差异 (P <0 .0 5 )。结论　盆底肌电刺激能有效治疗OAB ,但长期疗效仍需进一步观察研究     

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.