Department of Urology, University of Texas Southwestern, Dallas, Texas 75390-9110, USA.
J Urol. 2013 Mar;189(3):976-9. doi: 10.1016/j.juro.2012.09.101. Epub 2012 Sep 25.
We report the prevalence of stress urinary incontinence and pelvic organ prolapse in patients with multiple sclerosis referred to a tertiary care neurogenic bladder clinic.
We queried an institutional review board approved neurogenic bladder database for urodynamic and demographic data on patients with multiple sclerosis followed for lower urinary tract symptoms in a 12-year period. Demographic information included multiple sclerosis classification, age at initial visit, body mass index, parity and pelvic examination findings. Prolapse was defined as stage 2 prolapse or greater. Stress urinary incontinence was defined as urodynamic stress incontinence and/or incontinence on a supine stress test.
Included in analysis were 280 women with a mean age of 50 years and a mean 13-year history of multiple sclerosis. Relapse remitting multiple sclerosis was noted in 40% of patients, while 45 (16%) had stress urinary incontinence. Women with stress urinary incontinence had a higher average maximum urine flow (14 vs 9 ml per second, p <0.003), higher voided volume (272 vs 194 cc, p = 0.018) and higher body mass index (30 vs 25 kg/m(2), p <0.005). Overall, 23 women (9%) had pelvic organ prolapse, including 2 (9%) with posterior prolapse only, 8 (35%) with anterior prolapse only and 13 (56%) with posterior and anterior prolapse. There was no difference in age, body mass index or multiple sclerosis subtype between women with vs without pelvic organ prolapse.
The 14% prevalence of demonstrable stress urinary incontinence and 9% rate of pelvic organ prolapse are markedly lower than published historical data on an age matched cohort without multiple sclerosis. The surprisingly low prevalence of stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis may be attributable to decreased activity, a neurogenically enhanced vesicourethral unit or other functional or anatomical etiologies.
我们报告了在一家三级神经源性膀胱诊所就诊的多发性硬化症患者中压力性尿失禁和盆腔器官脱垂的患病率。
我们在一项机构审查委员会批准的神经源性膀胱数据库中查询了在 12 年内随访下尿路症状的多发性硬化症患者的尿动力学和人口统计学数据。人口统计学信息包括多发性硬化症分类、首次就诊时的年龄、体重指数、产次和盆腔检查结果。脱垂定义为 2 期或更高级别的脱垂。压力性尿失禁定义为尿动力学压力性尿失禁和/或仰卧位压力试验时的失禁。
分析纳入了 280 名平均年龄为 50 岁、多发性硬化症平均病史为 13 年的女性。40%的患者为复发缓解型多发性硬化症，45 名（16%）患有压力性尿失禁。患有压力性尿失禁的女性平均最大尿流率较高（14 比 9ml/秒，p<0.003），排空量较高（272 比 194cc，p=0.018），体重指数较高（30 比 25kg/m2，p<0.005）。总体而言，23 名女性（9%）患有盆腔器官脱垂，其中 2 名（9%）仅为后位脱垂，8 名（35%）仅为前位脱垂，13 名（56%）为前后位脱垂。有或没有盆腔器官脱垂的女性在年龄、体重指数或多发性硬化症亚型方面无差异。
有症状的压力性尿失禁患病率为 14%，盆腔器官脱垂率为 9%，明显低于无多发性硬化症的年龄匹配队列的既往文献数据。多发性硬化症女性中压力性尿失禁和盆腔器官脱垂的低患病率可能归因于活动减少、神经源性增强的下尿路单位或其他功能或解剖病因。
