女性膀胱过度活动症

膀胱过度活动症(overactive bladder,OAB)是一种以尿急症状为特征的症候群,尿动力学表现为逼尿肌过度活动或其他膀胱尿道功能障碍,实验室检查排除明确感染证据和病理学改变,以症状学诊断为基础。OAB无论对个人还是社会都可视为沉重负担。女性OAB发生率高,且随年龄呈线性增加,属临床常见疾患。目前国内妇产科医师对OAB尚属陌生。该类疾病知识不仅泌尿科医师应该掌握,妇产科医师亦应了解,有利于临床工作中做出正确识别及处理。     

膀胱过度活动症

膀胱过度活动症(overactive bladder,OAB)是常见的排尿功能障碍的临床表现之一．亦是目前国内外的研究热点。现就OAB有关的临床研究进展介绍如下。     

小儿膀胱过度活动症106例治疗报告

目的探讨小儿膀胱过度活动症的临床特点及治疗方法。方法回顾分析近5年门诊收治的106例小儿膀胱过度活动症的临床表现、个性化治疗方法及疗效。结果38例学龄前患儿经心理疏导、改变生活习惯等方法治疗,30例治愈,治愈率78．9％。其余76例患儿予口服654．2片,其中58例治愈,治愈率76．3％;另18例加服硝苯吡啶联合治疗,16例治愈,2例好转。总治愈率98．1％。结论小儿膀胱过度活动症治疗应根据个人特点采取个性化治疗方案,治愈后复发率低。     

腺性膀胱炎合并膀胱过度活动症的诊治分析

目的探讨腺性膀胱炎合并膀胱过度活动症的临床诊断与治疗。方法回顾分析2007年1月~2009年10月收治的132例经病理确诊的腺性膀胱炎患者的临床资料。结果 132例患者随访3~28月,治愈85例（68.7%）,好转38例（24.9%）,未愈9例（6.4%）;合并有膀胱过度活动症34例,经托特罗定治疗2周后26例尿急、尿频、夜尿好转,4例急迫性尿失禁缓解,4例治疗后无效,加用盐酸坦索罗辛缓释胶囊治疗2周后症状缓解。结论经尿道电切术联合化疗药膀胱灌注治疗腺性膀胱炎疗效满意,但不能忽视合并有膀胱过度活动症的诊断与治疗。     

膀胱过度活动症临床指导原则

前言　膀胱过度活动症是近年国际尿控学会 (ＩＣＳ)提出的新概念 ,泛指逼尿肌功能异常所致的尿频、尿急和急迫性尿失禁。为尽快普及ＯＡＢ的诊疗技术 ,提高我国尿失禁的诊治水平 ,中华医学会泌尿外科分会尿控学组召开的关于《膀胱过度活动症临床指导原则》的研讨会于 2 0 0 2年     

索利那新治疗膀胱过度活动症106例报告

目的评价索利那新治疗膀胱过度活动症（OAB）的疗效。方法对106例诊断OAB的患者口服索利那新,5mg,每天1次;治疗前后患者填写排尿日记,疗程4周,以膀胱过度活动症评分（OABSS）为观察指标。结果治疗后患者OABSS较治疗前改善,两者差异有统计学意义（P〈0.05）。结论索利那新具有更高的膀胱选择性,疗效确切,药物耐受性好,值得推荐临床一线用药。     

托特罗定治疗女性膀胱过度活动症26例疗效分析

目的探讨女性膀胱过度活动症的治疗方法。方法回顾性分析采用托特罗定治疗26例女性膀胱过度活动症患者的临床资料,并结合文献复习。结果本组26例治疗6～8周后,获得随访21例。随访时间3～12个月,平均6.5个月。其中18/21例有效(85.7%),10/21例症状完全消失(47.6%),8/21症状明显好转(38.1%);3/21例无效(14.5%)。仅少数患者有轻微口干和排尿费力不适反应。结论初步观察,托特罗定是一种治疗女性膀胱过度活动症耐受性好、安全有效的药物。     

宁泌泰胶囊辅助治疗女性膀胱过度活动症132例报告

目的:观察宁泌泰胶囊辅助治疗女性膀胱过度活动症(Overactive bladder,OAB)的治疗效果.方法:将132例女性OAB患者随机分为实验组和对照组.实验组66例,用M受体拮抗剂,同时加用宁泌泰胶囊;对照组66例,单用M受体拮抗剂,两组疗程均为2周.结果:实验组的临床治愈率为45.45%,总有效率为93.93%;对照组的临床治愈率为30.33%,总有效率为90.91%,两组比较差异有统计学意义(P＜0.05).结论:宁泌泰胶囊辅助治疗女性膀胱过度活动症是有效的.     

膀胱过度活动症研究进展

膀胱过度活动症 (ｏｖｅｒａｃｔｉｖｉｔｙｂｌａｄ ｄｅｒ )简称膀胱过动症 ,包括不稳定膀胱及逼尿肌反射亢进 ,在神经性膀胱称为逼尿肌反射亢进 ,在非神经性膀胱则称为逼尿肌不稳定[1,2 ] 。一、膀胱尿道活动的神经控制排尿活动分为非主动及主动排尿活动两种 ,后者主要指排尿期因某种原因要求中止排尿 ,而贮尿期因某种原因要求开始排尿与非主动性排尿活动无甚区别[3 ] 。非主动排尿活动 :排尿活动属人类情感运动 ,情感运动中枢在视前区及中脑导水管区 ,调节排尿、性活动等。中脑导水管周围黑质接受经盆神经传入的膀胱副交感Ａ δ传入纤维…     

膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效探讨

目的探讨膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效。方法经膀胱训练和抗胆碱能药物等常规治疗无效的女性膀胱过度活动症患者8例，年龄23-62岁，平均42岁。患者均有尿急、尿频、夜尿增多症状，无急迫性尿失禁。膀胱镜下将肉毒素A200U注射于膀胱逼尿肌内，散在注射20-30点，并在尿道括约肌注射4点以防止术后尿潴留。记录治疗前及治疗6周后的排尿日记、常规尿动力学检查结果和患者症状改善情况，进行疗效评价。结果8例患者治疗6周后，排尿日记显示日排尿次数由（12．2±2．4）次减至（7．5±2．2）次（P〈0．05），夜尿次数由（2．2土0．3）次减至（1．8土0．4）次（P〉0．05）。尿动力学检查初始尿意时膀胱容量由（132．5±32．8）ml增至（190．2±37．6）ml（P〉0．05），膀胱最大容量由（217．3±34．6）ml增至（320．6±27．4）ml（P〈0．05）。2例治疗前尿动力学检查具有逼尿肌不稳定表现患者，1例逼尿肌不稳定消失，另1例初次不稳定收缩时膀胱容量由126ml增加到194ml。8例患者均未出现尿潴留、尿失禁等排尿并发症及全身不良反应，均对治疗效果满意，疗效持续5-9个月。结论膀胱内注射肉毒素A是治疗女性膀胱过度活动症安全有效的手段。     

The prevalence of chronic constipation and faecal incontinence among men and women with symptoms of overactive bladder

Study Type – Symptom prevalence (non‐consecutive cohort)
Level of Evidence 4 What’s known on the subject? and What does the study add? There have been no previous studies examining the overlap of chronic constipation and overactive bladder in the US population. Limited research to date based on samples of elderly, Asian and pediatric populations suggests that there is substantial overlap. The results of this study suggest that the prevalence of chronic constipation is increased in people with overactive bladder who are ≥40 years and should be considered by healthcare providers treating these patients.

OBJECTIVE

To estimate the prevalence and overlap of overactive bladder (OAB), chronic constipation (CC) and faecal incontinence (FI) among a general population sample of adults in the USA.

PATIENTS AND METHODS

A cross‐sectional internet‐based survey of randomly selected panel members who were ≥40 years of age was conducted. Participants reported how often they experienced symptoms of OAB, CC and FI using Likert scales and modified Rome III criteria. Analyses were conducted to examine the overall prevalence of OAB, CC and FI in men and women separately and to characterize the extent of overlap between these conditions in participants with OAB vs those without OAB, and those participants with continent vs incontinent OAB.

RESULTS

The response rate for the survey was 62.2% and the final sample (N= 2000) included 927 men and 1073 women. The overall prevalence of OAB [defined as a response of ≥‘sometimes’ to urinary urgency (i.e. ‘sometimes’ or more often) or ‘yes’ to urinary urgency incontinence (UUI)] was 26.1% in men and 41.2% in women. The overall prevalence of CC was significantly lower in men than in women (15.3 vs 26.3%), but both men and women with OAB were significantly more likely to report CC (22.3 and 35.9% vs 5.7 and 6.7%, respectively, P < 0.0001). The overall prevalence of FI reported ‘rarely’ or more was 16.7% of men and 21.9% of women. Men and women with OAB were significantly more likely to report FI than those without OAB. FI was also more common in participants with incontinent OAB than in those with continent OAB. Logistic regressions controlling for demographic factors and comorbid conditions suggest that OAB status is a very strong predictor of CC, FI and overlapping CC and FI (odds ratios, range 3.55–7.96).

CONCLUSIONS

Chronic constipation, FI and overlapping CC and faecal incontinence occur more frequently in patients with OAB and should be considered when evaluating and treating patients with OAB. These findings suggest a shared pathophysiology among these conditions. Additional study is needed to determine if successful treatment of one or more of these conditions is accompanied by commensurate improvement in symptoms referable to the other organ system.     

Nocturnal enuresis and overactive bladder in children: An epidemiological study

AIMS: To investigate the prevalence and characteristics of nocturnal enuresis (NE) and to examine the prevalence of overactive bladder (OAB) symptoms in primary schoolchildren. METHODS: After conducting an anonymous questionnaire survey about voiding habits and bowel habits in primary schoolchildren, a total of 6917 schoolchildren belonging to 11 primary schools were randomly enrolled in the survey. According to the International Continence Society, we defined NE as any involuntary loss of urine during sleep, occurring more frequently than once per month. Children with NE were subdivided into two groups, monosymptomatic NE (MNE) and enuretic syndrome (ES). To evaluate the characteristic differences of MNE and ES, we assessed the relationships between NE and voiding habits, and episodes of cystitis and constipation. Overactive bladder was defined as increased daytime frequency and/or urge urinary incontinence, and its prevalence was investigated. RESULTS: The response rate to the questionnaire was 76.4%. The prevalence of NE was 5.9% and was inversely related to increasing age. Monosymptomatic NE comprised 59.4% of NE cases. The annual spontaneous resolution rate of MNE was higher than that of ES. Increased daytime frequency, a history of cystitis and infrequent bowel habits were not related to MNE, but were significantly related to ES. The prevalence of OAB was 17.8%. Children with a history of cystitis had a significantly higher rate of OAB than children without it. CONCLUSIONS: Overall, NE and OAB were detected in 5.9% and 17.8% of primary schoolchildren, respectively. The link between NE and OAB symptoms, urinary tract infections and constipation deserves more attention.     

Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder

OBJECTIVES: To compare the efficacy of tolterodine plus simplified bladder training (BT) with tolterodine alone in patients with an overactive bladder. PATIENTS AND METHODS: In a multicentre, single-blind study at 51 Scandinavian centres, 505 patients aged >or= 18 years with symptoms of urinary frequency (>or= 8 micturitions/24 h) and urgency, with or without urge incontinence, were randomized to oral treatment with either tolterodine 2 mg twice daily plus simplified BT or tolterodine alone. Changes in voiding diary variables were evaluated after 2, 12 and 24 weeks of treatment. The patients' perceptions of their bladder symptoms and tolerability (adverse events) were also determined. RESULTS: In all, 501 patients (75% women) were evaluable on an intention-to-treat basis (244 on tolterodine + BT and 257 on tolterodine alone). Tolterodine significantly reduced the voiding frequency and increased the volume voided per void at all sample times; these effects were significantly increased by adding BT. At the end of the study the median percentage reduction in voiding frequency was greater with tolterodine + BT than with tolterodine alone (33% vs 25%, P < 0.001), while the median percentage increase in volume voided per void was 31% with tolterodine + BT and 20% with tolterodine alone (P < 0.001). There was a median of 81% fewer incontinence episodes than at baseline with tolterodine alone, which was not significantly different from that with tolterodine + BT (- 87%). The two groups had comparable median percentage reductions in urgency episodes. Some 76% of patients on tolterodine + BT reported an improvement in their bladder symptoms relative to baseline, compared with 71% on tolterodine alone. Tolterodine was well tolerated; the most common adverse event was mild dry mouth. CONCLUSION: Tolterodine 2 mg twice daily is an effective and well tolerated treatment for an overactive bladder, the effectiveness of which can be augmented by a simplified BT regimen.     

骶神经根功能性磁刺激对脊髓损伤后神经源性膀胱过度活动症的作用

目的:观察骶神经根功能性磁刺激(functional magnetic stimulation,FMS)对脊髓损伤患者神经源性膀胱过度活动症(overactive bladder,OAB)治疗的效果。方法:将40例脊髓损伤后OAB患者按随机数字表法分为治疗组(20例)和对照组(20例)。两组患者均给予常规的膀胱功能干预,治疗组在此基础上给予骶神经根FMS(强度为70%～100%最大输出强度,频率15Hz,每分钟刺激5s,共刺激30min,每日1次,每周5次,共治疗8周),对照组则给予相同参数FMS(刺激线圈与治疗部位垂直,无刺激作用)。两组患者均于治疗前和8周后比较尿流动力学指标(初尿意时膀胱容量、最大膀胱测压容量、残余尿量)、排尿日记指标(单次尿量、排尿次数和最大排尿量)及因排尿不良而引起生活质量评分变化。结果:治疗8周后,两组患者尿流动力学及排尿日记指标较术前均显著改善。初尿意时膀胱容量(对照组65.25±6.41ml、治疗组78.44±9.52ml)增加(P0.05),最大膀胱测压容量(对照组339.55±36.75ml、治疗组394.46±36.68ml)显著增加(P0.05),残余尿量(对照组120.22±40.35ml、治疗组88.25±33.61ml)明显减少(P0.05);日均单次排尿量(对照组120.06±23.23ml、治疗组150.28±24.24ml)增加(P0.05),24h平均排尿次数(对照组12.28±3.31、治疗组9.44±3.95)减少(P0.05),最大排尿量(对照组233.58±47.14ml、治疗组274.51±30.18ml)显著改善(P0.05);因排尿症状而引起生活质量评分均明显降低;与组内治疗前比较,差异均有统计学意义(P0.05),且治疗组改善情况均显著优于对照组(P0.05)。结论:FMS可改善神经源性膀胱过度活动症患者的膀胱功能和提高患者的生存质量。     

Evaluation of functional bladder capacity in Japanese children

BACKGROUND: Functional bladder capacity is a very important factor in the diagnosis of children with voiding disorders. Because Japanese children are thought to have somewhat smaller functional bladder capacity compared with Western children, the convenient formula (so-called Koff formula) bladder capacity (in ounces) = age (in years)+ 2 is not suitable for use in Japanese children. METHODS: We measured the bladder capacities of 131 Japanese children aged 5-15 years without clinical voiding pattern abnormalities to develop a practical guideline for the prediction of normal bladder capacity for age. RESULTS: An approximate formula relates age and bladder capacity as: bladder capacity (mL) = 25 x (age (years) + 2). CONCLUSIONS: The formula presented is thought to be a useful guide for the diagnosis of small, normal or large bladder capacity and offers information on voiding disorders in Japanese children.