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首页> 外文期刊>Nature reviews. Urology >Management of neurogenic bladder in patients with multiple sclerosis
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Management of neurogenic bladder in patients with multiple sclerosis

机译：多发性硬化症患者的神经源性膀胱管理

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Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.
机译：下尿路（LUT）功能障碍在多发性硬化症患者中很常见，并且对这些患者的生活质量产生重大负面影响。最常报告的症状是贮藏期的症状，逼尿肌过度活动是最常报告的尿动力学异常。对患者LUT症状的临床评估应包括膀胱日记，尿流法，然后测量空腹残留尿量，尿液分析，超声检查，肾功能评估，生活质量评估以及有时进行尿动力学检查和/或膀胱镜检查。这些患者的治疗需要多学科的方法。间歇性自我导尿是处理不完全膀胱排空和尿retention留的首选方法。抗毒蕈碱类药物是具有贮藏症状的患者的一线治疗。如果抗毒蕈碱药无效或耐受不良，则可以采用其他方法，例如注射Intrutrusor肉毒杆菌毒素A，胫骨神经刺激和神经调节，在多发性硬化症患者中证据水平不同。仅在仔细选择患者后才能进行手术。由于括约肌缺乏引起的压力性尿失禁仍然是治疗上的挑战，并且只有在保守治疗措施失败的情况下才能通过外科手术加以控制。多发性硬化症具有进行性病程，因此，患者的LUT症状需要定期的长期随访监测。

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