Fowler C J, Panicker J N, Drake M, Harris C, Harrison S C W, Kirby M, Lucas M, Macleod N, Mangnall J, North A, Porter B, Reid S, Russell N, Watkiss K, Wells M
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Neurosurg Psychiatry. 2009 May;80(5):470-7. doi: 10.1136/jnnp.2008.159178.
Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients' continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed.
多发性硬化症（MS）中的膀胱症状很常见且令人苦恼，但也非常适合治疗。最近召开了一次由参与患者尿失禁护理的利益相关者组成的会议，其中包括神经科医生、泌尿科医生、初级保健医生、MS护士和护理团体，以制定英国的管理共识。基于对文献的回顾和专家意见，采用了英国国家卫生与临床优化研究所（NICE）的标准来提出建议。会议达成共识，在大多数情况下，成功的管理可以基于一个简单的算法，该算法包括使用试剂棒检测尿液感染以及测量排尿后残余尿量。这与其他国家发布的推荐膀胱测压法的指南形成对比。在疾病的整个过程中，应为患者提供治疗尿失禁的适当管理方案，其中主要方法是抗毒蕈碱药物，必要时可联合清洁间歇性自我导尿。对包括物理治疗、旨在改善膀胱排空的替代策略、其他药物以及膀胱内注射肉毒杆菌毒素A等其他措施的证据进行了审查。讨论了尿路感染的管理以及作为严重残疾一部分的膀胱问题，并达成了相关建议。
