Araki Isao, Matsui Makoto, Ozawa Kyoko, Takeda Masayuki, Kuno Sadako
Department of Urology, Utano National Hospital, Kyoto, Japan.
J Urol. 2003 Apr;169(4):1384-7. doi: 10.1097/01.ju.0000049644.27713.c8.
We investigated the relationship of voiding dysfunction type and the lesion site in patients with multiple sclerosis.
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.
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.
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.
我们研究了多发性硬化症患者排尿功能障碍类型与病变部位之间的关系。
使用国际前列腺症状评分和尿动力学检查对32例多发性硬化症患者的排尿功能障碍进行评估。通过联合神经学检查和磁共振成像结果确定病变部位。
与西方国家的报告相比，日本排空症状与充盈症状的比例较高。在泌尿症状中，只有充盈与残疾状态和病程相关。泌尿症状与病变部位无关。尿动力学评估显示，32例患者中有14例存在逼尿肌反射亢进，12例存在反射减退或无反射，4例存在逼尿肌反射亢进伴收缩功能受损，1例膀胱顺应性低，1例功能正常。在14例反射亢进患者中，13例同时存在括约肌过度活跃。在2例逼尿肌反射亢进伴收缩力受损的患者和1例膀胱顺应性低的患者中发现括约肌功能不全。发现脑桥病变与逼尿肌反射减退、颈髓病变与逼尿肌-括约肌协同失调之间存在显著相关性。
逼尿肌反射减退和逼尿肌-括约肌协同失调分别提示脑桥和颈髓病变。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。
