Chancellor Michael B, Anderson Rodney U, Boone Timothy B
Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
Am J Phys Med Rehabil. 2006 Jun;85(6):536-45. doi: 10.1097/01.phm.0000219229.92056.c2.
Chancellor MB, Anderson RU, Boone TB: Pharmacotherapy for neurogenic detrusor overactivity. Am J Phys Med Rehabil 2006;85:536-545. Patients with neurogenic detrusor overactivity are a heterogeneous group with voiding dysfunction secondary to neurologic injury or disease. The neurogenic detrusor overactivity syndrome, which may include urinary frequency, urgency, and incontinence, frequently contributes to a loss of independence, or even institutionalization. Urodynamic assessment provides the best method of quantifying and classifying neurogenic detrusor overactivity dysfunction in patients with primary diagnoses as diverse as Parkinson's disease, cerebral palsy, multiple sclerosis, spinal cord injury, and spina bifida. For many patients, management of urinary symptoms includes pharmacotherapy with an anticholinergic agent. Several novel approaches to managing neurogenic detrusor overactivity, including intravesical instillation of anticholinergic agents, vanilloids, and neurotoxins, are being investigated. For most patients, however, flexible dosing with an anticholinergic agent, with clean intermittent catheterization when indicated, has been shown to reduce the risks of urologic complications, improve levels of continence, and enhance patient quality of life in both children and adults.
钱塞勒·MB、安德森·RU、布恩·TB：神经源性逼尿肌过度活动的药物治疗。《美国物理医学与康复》2006年；85：536 - 545。神经源性逼尿肌过度活动患者是一个异质性群体，存在继发于神经损伤或疾病的排尿功能障碍。神经源性逼尿肌过度活动综合征，可能包括尿频、尿急和尿失禁，常常导致患者失去独立生活能力，甚至需要住进护理机构。尿动力学评估为量化和分类神经源性逼尿肌过度活动功能障碍提供了最佳方法，这些患者的初始诊断多种多样，如帕金森病、脑瘫、多发性硬化症、脊髓损伤和脊柱裂。对许多患者而言，排尿症状的管理包括使用抗胆碱能药物进行药物治疗。目前正在研究几种治疗神经源性逼尿肌过度活动的新方法，包括膀胱内灌注抗胆碱能药物、香草酸类药物和神经毒素。然而，对大多数患者来说，灵活使用抗胆碱能药物，并在必要时进行清洁间歇性导尿，已被证明可降低泌尿系统并发症的风险，提高控尿水平，并改善儿童和成人患者的生活质量。
