Fowler C J, van Kerrebroeck P E, Nordenbo A, Van Poppel H
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Neurosurg Psychiatry. 1992 Nov;55(11):986-9. doi: 10.1136/jnnp.55.11.986.
Bladder symptoms in patients with multiple sclerosis (MS) are common and usually arise as a result of spinal lesions which interrupt the neural pathways connecting the pontine micturition centre to the sacral spinal cord. Thus these symptoms are particularly likely to occur in those with lower limb neurological deficits. Fortunately bladder dysfunction in MS is rarely associated with serious upper tract disease so that the problem is usually one of symptomatic management. Lower urinary tract symptoms may be both "irritative" or "obstructive" in nature and can be explained in terms of underlying detrusor hyperreflexia and incomplete bladder emptying. Treatment is aimed at minimising both these effects. Oral anticholinergic medication can be effective in reducing detrusor hyperreflexia and intermittent catheterisation is used to reduce abnormally high post micturition residual volumes. With this simple treatment, often used in combination, many less severely affected patients with MS can gain considerable improvement in controlling urinary continence.
多发性硬化症（MS）患者的膀胱症状很常见，通常是由脊髓病变引起的，这些病变会中断连接脑桥排尿中枢与骶脊髓的神经通路。因此，这些症状在下肢神经功能缺损患者中尤其容易出现。幸运的是，MS患者的膀胱功能障碍很少与严重的上尿路疾病相关，所以问题通常在于症状管理。下尿路症状本质上可能是“刺激性”或“梗阻性”的，并且可以根据潜在的逼尿肌反射亢进和膀胱排空不完全来解释。治疗旨在将这两种影响降至最低。口服抗胆碱能药物可有效减轻逼尿肌反射亢进，间歇性导尿用于减少排尿后异常高的残余尿量。通过这种经常联合使用的简单治疗方法，许多病情较轻的MS患者在控制尿失禁方面可获得显著改善。
