Panicker Jalesh, Haslam Collette
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London.
Br J Community Nurs. 2009 Nov;14(11):474, 476, 478-80. doi: 10.12968/bjcn.2009.14.11.45004.
Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 mls. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. There are specific situations where specialist urology services should be involved.
多发性硬化症患者的下尿路功能障碍很常见，且极易治疗。患者可能存在膀胱储尿和/或排尿功能障碍。进展为肾衰竭的风险较低，因此在大多数患者中，下尿路功能障碍应被视为可通过医学手段控制。评估从病史采集开始，并通过膀胱日记加以补充。超声检查用于评估膀胱排空不全的程度以及上尿路损伤情况。膀胱排空不全通常通过清洁间歇性自我导尿来处理，如果排尿后残余尿量超过100毫升，就应开始导尿。储尿症状通常使用抗毒蕈碱药物进行处理。其他选择包括去氨加压素或向逼尿肌注射A型肉毒杆菌毒素。在某些特定情况下，应寻求专业泌尿外科服务的帮助。
