Cameron Anne P, Clemens J Quentin, Latini Jerilyn M, McGuire Edward J
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA.
J Urol. 2009 Sep;182(3):1062-7. doi: 10.1016/j.juro.2009.05.038. Epub 2009 Jul 18.
Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an alpha-blocker.
A retrospective chart review was performed identifying all patients with neurogenic bladder dysfunction who were initially on no drug therapy or antimuscarinic therapy alone and were later switched to 2 or 3 drug therapy.
In the group initially on no therapy and subsequently on 2 drugs (22) mean bladder pressure at capacity decreased 52% and mean compliance increased 5.0-fold. Similarly in the group starting without therapy but ending up on 3 drugs (28) bladder pressure decreased 67% and compliance increased 9.7-fold. In the group initially on an antimuscarinic agent alone (27) triple drug therapy decreased bladder pressure 60% and compliance increased 3.0-fold (all p <0.01). There were also improvements in incontinence, vesicoureteral reflux, detrusor overactivity and detrusor sphincter dyssynergia.
In this highly selected group of patients with neurogenic bladder dysfunction and poor bladder compliance combination medical therapy with 2 or 3 drugs improved compliance, decreased bladder pressures at capacity and improved clinical outcomes. Combination therapy requires further study of the side effect profile but these results suggest that it should be considered for patients in whom antimuscarinic agents alone fail.
对于与神经源性膀胱功能障碍相关的膀胱储尿压力升高和顺应性降低，典型的治疗方法包括使用或不使用间歇性清洁导尿的抗胆碱能治疗。然而，这些措施往往不成功。在这个患者群体中，我们通常使用抗胆碱能药物与丙咪嗪和/或α受体阻滞剂联合的联合治疗。
进行了一项回顾性图表审查，确定所有最初未接受药物治疗或仅接受抗胆碱能治疗，后来改为接受两种或三种药物治疗的神经源性膀胱功能障碍患者。
在最初未接受治疗，随后接受两种药物治疗的组（22例）中，膀胱容量时的平均膀胱压力降低了52%，平均顺应性增加了5.0倍。同样，在开始未接受治疗但最终接受三种药物治疗的组（28例）中，膀胱压力降低了67%，顺应性增加了9.7倍。在最初仅接受抗胆碱能药物治疗的组（27例）中，三联药物治疗使膀胱压力降低了60%，顺应性增加了3.0倍（所有p<0.01）。尿失禁、膀胱输尿管反流、逼尿肌过度活动和逼尿肌括约肌协同失调也有改善。
在这个经过高度筛选的神经源性膀胱功能障碍且膀胱顺应性差的患者群体中，两种或三种药物的联合药物治疗改善了顺应性，降低了膀胱容量时的压力，并改善了临床结果。联合治疗需要进一步研究副作用情况，但这些结果表明，对于单独使用抗胆碱能药物无效的患者应考虑使用联合治疗。
