GENITOURINARY DYSFUNCTION IN MULTIPLE SYSTEM ATROPHY - CLINICAL-FEATURES AND TREATMENT IN 62 CASES
GENITOURINARY DYSFUNCTION IN MULTIPLE SYSTEM ATROPHY - CLINICAL-FEATURES AND TREATMENT IN 62 CASES
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DOI：
10.1016/s0022-5347(17)35246-1
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发表时间：
1994-05-01
影响因子：
6.6
通讯作者：
FOWLER, CJ
中科院分区：
文献类型：
--
作者：
BECK, RO;BETTS, CD;FOWLER, CJ
多系统萎缩是一种以中枢神经系统某些部位的进行性神经元萎缩为特征的疾病，其中一些在泌尿生殖功能的控制中是重要的。本文描述了62例患者的神经泌尿系统特征。所有的患者都有异常的尿道或肛门括约肌肌电图时，进行了个别的运动单位分析，发现诊断条件在适当的临床环境中，immune发生在96%的男性和37%的第一个症状。排尿症状是由逼尿肌反射亢进和尿道括约肌无力以及逼尿肌收缩失败引起的。在男性中，这些症状类似于流出道梗阻，因此43%在正确诊断之前接受了前列腺或膀胱颈手术。57%的女性发生压力性尿失禁，其中一半接受了手术。手术治疗的效果不佳，间歇性导尿、抗胆碱能药物和去氨加压素喷雾剂治疗后，82%的患者的排尿功能明显改善。认识到这种疾病和引进有效的，非手术治疗的重要性是强调。
Multiple system atrophy is a disorder characterized by progressive neuronal atrophy at certain sites of the central nervous system, several of which are important in the control of urogenital function. The neurourological features of 62 patients with this condition are described. All patients had abnormal urethral or anal sphincter electromyography when individual motor unit analysis was performed, a finding diagnostic of the condition in the appropriate clinical setting.Impotence occurred in 96% of the men and was the first symptom alone in 37%. Urinary symptoms resulted from a combination of detrusor hyperreflexia and urethral sphincter weakness followed by failure of detrusor contraction. In men these symptoms simulated those of outflow obstruction so that 43% underwent prostatic or bladder neck surgery before the correct diagnosis was made. Stress incontinence occurred in 57% of the women and of these half had undergone surgery. The results of surgery in both sexes were poor.Treatment with intermittent catheterization, anticholinergic medication and desmopressin spray markedly improved continence in 82%. The importance of recognizing this disorder and introducing effective, nonoperative treatments is stressed.