Desi M, Pelhuche A, Benoit G
Service de Neurologie, Hôpital de Bicêtre.
Prog Urol. 1992 Oct;2(5):925-32.
Vesicosphincteric disorders are frequent in patients with Parkinson's disease, due to a lesion of the locus niger of the extrapyramidal tract which no longer secretes sufficient dopamine to activate the nigrostriatal tract. The commonest symptoms are urgent micturition, dysuria or a combination of the two. 50% of patients with Parkinson's disease present with disturbances of micturition and these symptoms may be presenting complaint of the disease in 10% of cases. Cystomanometry reveals detrusor hyperactivity in more than 60% of cases and hypoactivity in less than 30% of case, while dyssynergia is less common. Delayed relaxation of the striated sphincter may sometimes be observed. Urological problems must therefore be distinguished from urological problems in these patients. A combined urological and urodynamic assessment is essential as the risk of incontinence following prostate surgery is 20%. Stress urinary incontinence in women may mask or be associated with urgency. These vesicosphincteric disorders must therefore be treated cautiously with a combination of medical treatment (dopatherapy increases detrusor control), retraining and occasionally surgery after a detailed urodynamic assessment.
膀胱括约肌功能障碍在帕金森病患者中很常见，这是由于锥体外系黑质受损，不再分泌足够的多巴胺来激活黑质纹状体通路。最常见的症状是尿急、排尿困难或两者兼有。50%的帕金森病患者存在排尿障碍，在10%的病例中，这些症状可能是该疾病的首发症状。膀胱测压显示，超过60%的病例存在逼尿肌活动亢进，不到30%的病例存在逼尿肌活动减退，而协同失调则较少见。有时可观察到横纹肌括约肌松弛延迟。因此，必须将这些患者的泌尿系统问题与其他泌尿系统问题区分开来。由于前列腺手术后尿失禁的风险为20%，因此联合进行泌尿系统和尿动力学评估至关重要。女性压力性尿失禁可能掩盖尿急或与之相关。因此，在详细的尿动力学评估后，必须谨慎地结合药物治疗（多巴胺治疗可增强逼尿肌控制）、再训练，偶尔进行手术来治疗这些膀胱括约肌功能障碍。
