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
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DOI：
10.1001/jama.257.22.3076
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发表时间：
1987-06-12
影响因子：
120.7
通讯作者：
YALLA, SV
中科院分区：
文献类型：
--
作者：
RESNICK, NM;YALLA, SV
尽管每年有 80 亿美元用于为尿失禁患者换尿布，但人们对住院老年人尿失禁的原因知之甚少。我们已经确定了一种特定的生理异常.sbd.逼尿肌过度活跃伴收缩功能受损 (DHIC).sbd.，虽然之前未被认识到，但它是这种情况下失禁的第二常见原因 (33%)。收缩功能受损的逼尿肌过度活跃是逼尿肌反射亢进的一个独特的生理子集，并呈现出一系列看似矛盾的发现：膀胱过度活跃但排空无效。这种排空受损是由于逼尿肌收缩功能减弱造成的，并且与膀胱小梁形成、膀胱收缩速度缓慢、逼尿肌储备力小以及大量残余尿有关。除了发病率高之外，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，并且可能需要改变当前膀胱功能障碍的分类学。此外，DHIC可能代表逼尿肌反射亢进自然史中的更高级阶段，该阶段的特征是逼尿肌收缩效率恶化。因此，这种以前未被认识的老年人失禁原因很常见，并引发了几个重要问题。
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.sbd.detrusor hyperactivity with impaired contractile function (DHIC).sbd.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 presented with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This impaired 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.