Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients.
Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients.
复制标题
逼尿肌过度活跃，收缩功能受损。
DOI：
10.1001/jama.1987.03390220074024
复制
发表时间：
1987
期刊：
影响因子：
--
通讯作者：
S. Yalla
中科院分区：
文献类型：
--
作者：
N. Resnick;S. Yalla
尽管每年有80亿美元用于为受影响的老年人提供尿布，但对机构老年人尿失禁的原因知之甚少。我们已经确定了一种特殊的生理异常-逼尿肌功能亢进伴收缩功能受损（DHIC）-虽然以前未被认识到，但它是这种情况下尿失禁的第二大常见原因（33%）。逼尿肌过度活动伴收缩功能受损是逼尿肌反射亢进的一个独特生理亚型，并呈现出一组看似矛盾的发现：膀胱过度活动但排空无效。这种排空障碍是由于逼尿肌收缩功能减弱，并与膀胱小梁形成、膀胱收缩速度慢、逼尿肌储备能力差和大量残余尿有关。除了其高患病率外，DHIC的重要性在于它可能表现为尿潴留，可能与前列腺出口梗阻非常相似，可能解释了为什么过去的逼尿肌反射亢进治疗试验失败，并且可能需要改变目前膀胱功能障碍的疾病分类。此外，DHIC可能代表逼尿肌反射亢进自然史中的更高级阶段，该阶段的特征在于逼尿肌收缩效率的恶化。因此，这种以前未被认识到的老年人尿失禁的原因是常见的，并提出了几个重要的问题。
Little is known about the causes of urinary incontinence in institutionalized elderly people, despite the fact that $8 billion is annually devoted to diapering those afflicted. We have identified a specific physiological abnormality--detrusor hyperactivity with impaired contractile function (DHIC)--that, although previously unrecognized, is the second most common (33%) cause of incontinence in this setting. Detrusor hyperactivity with impaired contractile function is a distinct physiological subset of detrusor hyperreflexia and presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This imparied emptying is due to diminished detrusor contractile function and is associated with bladder trabeculation, a slow velocity of bladder contraction, little detrusor reserve power, and a significant amount of residual urine. Aside from its high prevalence, the importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction. Furthermore, DHIC may represent a more advanced stage in the natural history of detrusor hyperreflexia, a stage characterized by deterioration of detrusor contractile efficiency. Thus, this previously unrecognized cause of incontinence in the elderly is common and raises several important issues.
DOI：
10.1056/nejm198509263131307
发表时间：
1985
期刊：
The New England journal of medicine
影响因子：
--
作者：
Resnick,NM;Yalla,SV
通讯作者：
Yalla,SV