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[基层医疗中尿失禁的转诊标准]

[Urine incontinence referral criteria for primary care].

作者信息

Brenes Bermúdez F J, Cozar Olmo J M, Esteban Fuertes M, Fernández-Pro Ledesma A, Molero García J M

机构信息

Medicina de Familia, Centro de Atención Primaria Llefià, Badalona, España. Coordinador del Grupo de Urología de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

出版信息

Semergen. 2013 May-Jun;39(4):197-207. doi: 10.1016/j.semerg.2012.11.005. Epub 2013 Jan 30.

DOI:10.1016/j.semerg.2012.11.005
PMID:23726731
Abstract

Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

摘要

尽管尿失禁(UI)的发病率很高,但医疗专业人员对这种疾病的认知度却很低,这种疾病本身并不严重,但却严重限制了患者的生活。基层医疗协会,即西班牙初级医疗医生协会[SEMERGEN]、西班牙普通及家庭医生协会[SEMG]、西班牙家庭与社区医学协会[semFYC],以及西班牙泌尿外科学会(EAU)共同制定了这份共识,提议提高全科医生的认知,并帮助他们进行诊断、治疗以及将患者转诊至泌尿科医生处。基层医疗的首要目标必须是检测尿失禁,因此对于40岁以上无症状女性和55岁以上无症状男性,一生中至少要进行一次机会性筛查。基于病史和体格检查的诊断,必须确定尿失禁的类型和严重程度,以便将严重病例转诊至泌尿科医生处。除膀胱过度活动症(OAB)外,非药物保守治疗是女性和男性单纯性尿失禁的首选治疗方法。抗毒蕈碱药物是唯一已证明对急迫性尿失禁(UUI)和OAB有效且安全的药物。对于有混合症状的男性,排除严重梗阻病例后,应选择α受体阻滞剂和抗毒蕈碱药物的联合治疗。

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