下尿路功能障碍的多发性硬化症患者的尿动力学检查结果与性功能之间的关系。

Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction.

机构信息

Department of Urology, University of Catania, Catania, Italy.

出版信息

Eur J Neurol. 2015 Mar;22(3):485-92. doi: 10.1111/ene.12595. Epub 2014 Nov 19.

DOI:10.1111/ene.12595

PMID:25410608

Abstract

BACKGROUND AND PURPOSE

Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MS patients with LUTD.

METHODS

From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate-severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings.

RESULTS

Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2 O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2 O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate-severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2 O was an independent predictor of moderate-severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55.

CONCLUSIONS

Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2 O, MCC <135 ml and compliance ≤3 ml/cmH2 O may significantly predict the presence of moderate-severe ED.

摘要

背景与目的

性障碍（SD）在多发性硬化症（MS）患者中普遍存在，并影响生活质量。此外，下尿路功能障碍（LUTD）在 MS 患者中也很常见。我们的目的是确定在一组伴有 LUTD 的 MS 患者中，尿动力学检查结果与 SD 之间的关系。

方法

2011 年 1 月至 2013 年 9 月，根据国际尿控协会的标准，对 135 例缓解期 MS 合并 LUTD 的患者进行首次尿动力学检查。使用扩展残疾状况量表评估神经功能损伤，使用女性性功能指数（FSFI）或国际勃起功能指数（IIEF-15）评估 SD。采用多变量逻辑回归分析，在调整了包括尿动力学检查结果在内的混杂因素后，确定女性 SD（FSFI<26.55）或中重度勃起功能障碍（ED）（IIEF-EF≤16）的预测因子。

结果

逼尿肌收缩时最大逼尿肌压力（PdetmaxIDC）≥20.0cmH2O 的患者 IIEF-EF、IIEF 总体满意度（IIEF-OS）、FSFI 唤醒、FSFI 润滑和 FSFI 高潮较低。最大膀胱容量（MCC）≥135ml 的患者 IIEF-EF、性交满意度（IIEF-IS）、性高潮功能（IIEF-OF）、性欲（IIEF-SD）、FSFI 唤醒、FSFI 润滑、FSFI 高潮、FSFI 满意度和 FSFI 疼痛较高。多变量逻辑回归分析显示，PdetmaxIDC≥20cmH2O（比值比[OR]6.7；P<0.05）和 MCC<135ml（OR 6.80；P<0.05）是中重度 ED 的预测因子。在包括所有先前变量的模型中，顺应性≤3ml/cmH2O 是中重度 ED 的独立预测因子（OR 14.49；P<0.01）。先前的变量与 FSFI<26.55 之间没有关系。