慢性脊髓损伤所致神经源性下尿路功能障碍患者膀胱管理临床指南-第2部分:保守和微创治疗

IF 0.8 Q4 UROLOGY & NEPHROLOGY Urological Science Pub Date : 2023-01-01 DOI:10.4103/UROS.UROS_116_22
Yao-Lin Kao, Jian-ting Chen, Sung-Lang Chen, I. Shao, Chung-Cheng Wang, I. Chiang, Yu-Chao Hsu, Kau-Han Lee, Wei-Chia Lee, T. Yeh, Y. Kuo, B. Chiang, C. Liao, Po-Cheng Chen, E. Meng, Yung-Chin Lee, H. Kuo
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引用次数: 2

摘要

慢性脊髓损伤(SCI)患者的膀胱管理通常从保守治疗或微创手术开始。本文报道台湾慢性脊髓损伤患者以患者为中心的神经源性下尿路功能障碍(NLUTD)膀胱治疗的最新证据和专家意见。我们评估了清洁间歇导管插入术(CIC)、膀胱造瘘术、药物治疗和微创治疗在治疗慢性SCI患者尿失禁和排尿功能障碍中的作用。慢性SCI患者的膀胱管理应个体化。应考虑上尿路保护和生活质量改善之间的平衡。手的灵活性、腹肌力量、膀胱感觉和尿道括约肌协同失调程度可能影响排尿效率和NLUTD的改善。逼尿肌内注射A型肉毒毒素(BoNT-A)已被证明能有效治疗SCI患者的神经源性逼尿肌过度活动。然而,一些患者在治疗后仍然需要CIC。尿道括约肌注射BoNT-ABoNT-A可有效放松协同功能障碍括约肌;然而,尿失禁的恶化通常限制了其在SCI患者中的应用。重复注射BoNT-ABoNT-A是维持治疗效果所必需的;因此,一些SCI患者可能会停止治疗,转而通过手术干预进行永久性膀胱管理。识别高危SCI患者对于预防慢性SCI-NLUTD患者的肾功能恶化非常重要。避免肾功能恶化和提高NLUTD SCI患者的生活质量是治疗的最重要方面。每年对膀胱和肾功能进行积极监测是必要的。
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Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury - Part 2: Conservative and minimally invasive treatment
Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.
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来源期刊
Urological Science
Urological Science UROLOGY & NEPHROLOGY-
CiteScore
1.20
自引率
0.00%
发文量
26
审稿时长
6 weeks
期刊最新文献
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