Hillman L J, Burns S P, Kraft G H
University of Washington, Department of Rehabilitation Medicine, USA.
Mult Scler. 2000 Dec;6(6):403-6. doi: 10.1177/135245850000600608.
Symptomatic bladder dysfunction occurs in the majority of patients with multiple sclerosis (MS). Although guidelines have been established for diagnosis and management of bladder dysfunction in these patients, they are sometimes overlooked in the primary care setting, leading to severe, life threatening complications. A 64-year-old male with a 31-year history of spastic quadriparetic MS and neurogenic bladder dysfunction managed with an indwelling catheter, presented to the hospital with worsening neurological function. He had developed increased weakness and cognitive impairment several weeks after being treated for a urinary tract infection (UTI). He had become unable to perform any activities of daily living or drive his power wheelchair. After an extensive work-up, he was found to have a large (14 x 18 x 30 cm) retroperitoneal abscess and multiple renal stones, including a large obstructing calculus in the collecting system near the ureteropelvic junction, and he underwent nephrectomy and abscess drainage. Of note, he had been found to have multiple renal stones and hydronephrosis on renal ultrasound 3 years earlier, but he had received no treatment. Following drainage of the abscess, his upper extremity neurological function returned to baseline, his cognitive status improved, and he regained the ability to perform activities of daily living. Patients with paralysis from MS, much like those with traumatic spinal cord injuries, are at grave risk of mortality and morbidity from undiagnosed and under-treated urinary complications. This case demonstrates that evaluation and appropriate treatment for complications of neurogenic bladder should be part of routine care for patients with MS. Current recommendations for evaluation and management of bladder dysfunction in patients with MS will be reviewed.
症状性膀胱功能障碍在大多数多发性硬化症（MS）患者中都会出现。尽管已经制定了针对这些患者膀胱功能障碍的诊断和管理指南，但在初级保健环境中这些指南有时会被忽视，从而导致严重的、危及生命的并发症。一名64岁男性，有31年痉挛性四肢瘫型MS病史及神经源性膀胱功能障碍，一直使用留置导尿管进行治疗，因神经功能恶化入院。他在接受尿路感染（UTI）治疗几周后出现了肌无力加重和认知障碍。他已无法进行任何日常生活活动，也无法驾驶电动轮椅。经过全面检查，发现他有一个巨大的（14×18×30厘米）腹膜后脓肿和多个肾结石，包括在输尿管肾盂交界处附近集合系统中的一个大的阻塞性结石，随后他接受了肾切除术和脓肿引流术。值得注意的是，3年前肾脏超声检查发现他有多个肾结石和肾积水，但他未接受任何治疗。脓肿引流后，他的上肢神经功能恢复到基线水平，认知状态改善，并且重新获得了进行日常生活活动的能力。MS所致瘫痪的患者，与创伤性脊髓损伤患者非常相似，面临着因未诊断和未治疗的泌尿系统并发症而导致死亡和发病的严重风险。该病例表明，对神经源性膀胱并发症的评估和适当治疗应成为MS患者常规护理的一部分。本文将对MS患者膀胱功能障碍评估和管理的当前建议进行综述。
