Relationship of bladder dysfunction to lesion site in multiple sclerosis
Relationship of bladder dysfunction to lesion site in multiple sclerosis
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DOI：
10.1097/01.ju.0000049644.27713.c8
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发表时间：
2003-04-01
影响因子：
6.6
通讯作者：
Kuno, S
中科院分区：
文献类型：
--
作者：
Araki, I;Matsui, M;Kuno, S
目的：材料与方法：对32例多发性硬化患者进行国际前列腺症状评分和尿动力学检查，分析其排尿功能障碍类型与病变部位的关系。病变部位确定相结合的神经系统检查和磁共振成像findings.Results：从西方国家的报告相比，在日本的空填充症状的比例很高。泌尿系统症状中仅充盈与残疾状态和病程相关。泌尿系统症状与病变部位无关。尿动力学检查显示逼尿肌反射亢进14例，反射减退或无反射12例，逼尿肌反射亢进伴收缩功能受损4例，膀胱顺应性降低1例，膀胱功能正常1例。14例反射亢进患者中13例同时伴有括约肌过度活动。在2例逼尿肌反射亢进伴收缩力受损的患者和1例低顺应性膀胱患者中发现了括约肌功能不全。一个显着的相关性注意到脑桥病变和逼尿肌反射减退，并为颈髓病变和逼尿肌括约肌dyssynergia.Conclusions：逼尿肌反射减退和逼尿肌括约肌dyssynergia是指示脑桥和颈脊髓病变，分别。因此，中枢神经系统的病变部位可能是膀胱和尿道括约肌功能障碍类型的主要决定因素。日本患者排空症状的高患病率可能反映了逼尿肌反射减退和逼尿肌-括约肌协同失调的患病率。
Purpose: We investigated the relationship of voiding dysfunction type and the lesion site in patients with multiple sclerosis.Materials and Methods: Voiding dysfunction was evaluated in 32 patients with multiple sclerosis using the International Prostate Symptom Score and urodynamic tests. Lesion sites were determined by combined neurological examination and magnetic resonance imaging findings.Results: Compared with reports from Western countries the ratio of emptying-to-filling symptoms was high in Japan. Of urinary symptoms only filling correlated with disability status and disease duration. Urinary symptoms were not related to lesion sites. Urodynamic evaluation revealed detrusor hyperreflexia in 14 of 32 patients, hyporeflexia or areflexia in 12, detrusor hyperreflexia with impaired contractile function in 4, a low compliance bladder in 1 and normal function in 1. Of 14 patients with hyperreflexia 13 had overactive sphincter concurrently. Incompetent sphincter was identified in 2 patients who had detrusor hyperreflexia with impaired contractility and in 1 with a low compliance bladder. A significant correlation was noted for a pontine lesion and detrusor hyporeflexia, and for a cervical cord lesion and detrusor-sphincter dyssynergia.Conclusions: Detrusor hyporeflexia and detrusor-sphincter dyssynergia are indicative of a pontine and cervical spinal cord lesion, respectively. Thus, the lesion site in the central nervous system may be a major determinant of the type of bladder and urethral sphincter dysfunction. The high prevalence of emptying symptoms in Japanese patients may reflect the prevalence of detrusor hyporeflexia and detrusor-sphincter dyssynergia.