The Unstable Detrusor
The Unstable Detrusor
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DOI：
10.1159/000075265
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发表时间：
2004-01
影响因子：
1.6
通讯作者：
P. Bulmer;P. Abrams
中科院分区：
文献类型：
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作者：
P. Bulmer;P. Abrams
逼尿肌不稳定(逼尿肌不稳定)是一种常见的男性和女性疾病，会导致患者的严重发病率，并给医疗保健提供者带来巨大的经济支出。这种情况与尿频、尿急和急迫性尿失禁的症状有关。这些症状的尴尬性质意味着患者往往不愿寻求医疗帮助，因此存在报告不足的情况。流行病学研究很难进行，但似乎表明，发病率随着年龄的增长而增加，不稳定的逼尿肌是男性尿失禁的最常见原因。尽管事实上，可能的解释是多因素的，而不是单一的潜在病理过程，但对于神经源性和肌源性的病因，病因学仍然有很大的争议。只有通过尿动力学检查才能做出诊断。在决定适当的治疗之前，临床医生必须评估疾病的严重程度及其对患者生活质量的影响。这是因为感觉到的患者生活质量的改善必须超过与治疗相关的任何潜在的发病率。药物治疗的基础是阻断膀胱毒胆碱受体。不幸的是，没有一种治疗方法是针对膀胱的，因此大多数药物治疗都有不必要的全身性抗胆碱能副作用。外科治疗通常包括一定程度的膀胱去神经，以减少膀胱的活动。这会导致排尿困难，患者需要长期进行自我导尿。
The unstable detrusor (detrusor instability), a common condition in men and women, causes significant morbidity in sufferers and a great financial expense to health care providers. The condition is associated with symptoms of urinary frequency, urgency and urge incontinence. The embarrassing nature of these symptoms means patients are often reluctant to seek medical help and as a consequence there is under-reporting. Epidemiological studies are difficult to perform but appear to show that incidence increases with age and that the unstable detrusor is the commonest cause of male urinary incontinence. The aetiology is still much debated with reasoned arguments for both neurogenic and myogenic causes, though in truth, the likely explanation is multifactorial rather than a single underlying pathological process. The diagnosis can only be made on urodynamic testing. Before deciding on suitable treatment, the clinician must assess the disease severity and also its impact on patient quality of life. This is because perceived improvement in patient quality of life must outweigh any potential morbidity associated with treatment. Pharmacotherapy is based on blocking bladder muscarinic receptors. Unfortu-nately, no treatment is bladder specific and therefore most drug therapies have unwanted systemic anticholinergic side effects. Surgical treatment often involves a degree of bladder denervation to reduce bladder activity. This can consequently produce voiding difficulties which necessitate patients to self-catheterise on a longterm basis.