Romanzi L J, Groutz A, Heritz D M, Blaivas J G
Weill Medical College, Cornell University, New York, New York, USA.
Neurourol Urodyn. 2001;20(3):249-57. doi: 10.1002/nau.1002.
Data regarding the prevalence and urodynamic characteristics of involuntary detrusor contractions (IDC) in various clinical settings, as well as in neurologically intact vs. neurologically impaired patients, are scarce. The aim of our study was to evaluate whether the urodynamic characteristics of IDC differ in various clinical categories. One hundred eleven consecutive neurologically intact patients and 21 consecutive neurologically impaired patients, referred for evaluation of persistent irritative voiding symptoms, were prospectively enrolled. All patients were presumed by history to have IDC, and underwent detailed clinical and urodynamic evaluation. Based on clinical evaluation, patients were placed into one of four categories according to the main presenting symptoms and the existence of neurological insult: 1) frequency/urgency; 2) urge incontinence; 3) mixed stress incontinence and irritative symptoms; and 4) neurogenic bladder. IDC was defined by detrusor pressure of > or = 15 cm H2O whether or not the patient perceived the contraction; or < 15 cm H2O if perceived by the patient. Eight urodynamic characteristics of IDC were analyzed and compared between the four groups. IDC were observed in all of the neurologically impaired patients, compared with 76% of the neurologically intact patients (P < 0.001). No correlation was found between amplitude of IDC and subjective report of urgency. All clinical categories demonstrated IDC at approximately 80% of cystometric capacity. Eighty-one percent of the neurologically impaired patients, compared with 97% of the neurologically intact patients, were aware of the IDC at the time of urodynamics (P < 0.04). The ability to abort the IDC was significantly higher among continent patients with frequency/urgency (77%) compared with urge incontinent patients (46%) and neurologically impaired patients (38%). In conclusion, when evaluating detrusor overactivity, the characteristics of the IDC are not distinct enough to aid in differential diagnosis. However, the ability to abort IDC and stop incontinent flow may have prognostic implications, especially for the response to behavior modification, biofeedback, and pelvic floor exercise.
关于不同临床情况下以及神经功能正常与神经功能受损患者中逼尿肌不自主收缩（IDC）的患病率及尿动力学特征的数据十分匮乏。我们研究的目的是评估IDC的尿动力学特征在不同临床类别中是否存在差异。连续纳入了111例神经功能正常的患者和21例神经功能受损的患者，这些患者因持续性刺激性排尿症状前来接受评估。所有患者根据病史推测患有IDC，并接受了详细的临床和尿动力学评估。根据临床评估，根据主要表现症状和神经损伤的存在情况，将患者分为四类：1）尿频/尿急；2）急迫性尿失禁；3）混合性压力性尿失禁和刺激性症状；4）神经源性膀胱。IDC的定义为：无论患者是否感知到收缩，逼尿肌压力≥15 cm H₂O；若患者感知到收缩，则逼尿肌压力<15 cm H₂O。分析并比较了四组之间IDC的八项尿动力学特征。所有神经功能受损的患者均观察到IDC，而神经功能正常的患者中这一比例为76%（P<0.001）。未发现IDC的幅度与尿急的主观报告之间存在相关性。所有临床类别中，在膀胱测压容量约80%时均出现IDC。81%的神经功能受损患者在尿动力学检查时意识到IDC，而神经功能正常的患者中这一比例为97%（P<0.04）。与急迫性尿失禁患者（46%）和神经功能受损患者（38%）相比，有尿频/尿急症状的控尿患者中止IDC的能力显著更高（77%）。总之，在评估逼尿肌过度活动时，IDC的特征不够明显，无法辅助进行鉴别诊断。然而，中止IDC并停止尿失禁的能力可能具有预后意义，尤其是对于行为改变、生物反馈和盆底肌锻炼的反应。
