Wyndaele Jean Jacques, Vodušek David B
Urology and Urological Rehabilitation, University of Antwerp and Antwerp University Hospital, Brasschaat, Belgium.
Division of Neurology, University Medical Center Ljubljana, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Handb Clin Neurol. 2015;130:143-64. doi: 10.1016/B978-0-444-63247-0.00009-2.
History and physical examination are the cornerstones of evaluation of the male patient with lower urinary tract (LUT) symptoms and (suspected) neurologic disorder, both to diagnose the nervous system lesion, and to get insight into the type of LUT dysfunction (LUTD). Non-neurologic LUTD needs to be ruled out. Laboratory testing is necessary to diagnose urinary infection. In those in whom neurogenic LUTD is probable, postvoid residual urine and urinary flow measurement generally rule out significant outflow obstruction and allow for basic symptomatic management. If symptomatology is complex or severe, or the pathophysiology uncertain, or invasive treatment planned, urodynamic or videourodynamic measurements should be performed to inform on bladder sensation, detrusor contractility, pressures generated in the bladder, as well as the behavior of bladder neck, the striated urethral sphincter, and urinary flow. This information is paramount to the clinician to plan management and consider prognosis. Assessment needs to be repeated, as chronic neurogenic LUTD is not a stable condition; in progressive neurologic diseases the nature of LUTD itself may change. The upper urinary tract needs to be checked and followed up regularly, particularly in patient groups in which high intravesical pressures may be generated.
病史和体格检查是评估有下尿路（LUT）症状和（疑似）神经疾病男性患者的基石，既能诊断神经系统病变，又能深入了解下尿路功能障碍（LUTD）的类型。需要排除非神经源性LUTD。实验室检查对于诊断泌尿系统感染是必要的。对于可能患有神经源性LUTD的患者，排尿后残余尿量和尿流测量通常可排除明显的流出道梗阻，并有助于进行基本的症状管理。如果症状复杂或严重，或病理生理情况不明，或计划进行侵入性治疗，则应进行尿动力学或影像尿动力学测量，以了解膀胱感觉、逼尿肌收缩力、膀胱内产生的压力，以及膀胱颈、尿道横纹括约肌和尿流的情况。这些信息对临床医生制定治疗方案和考虑预后至关重要。由于慢性神经源性LUTD并非稳定状态，因此需要重复评估；在进行性神经疾病中，LUTD本身的性质可能会发生变化。需要定期检查和随访上尿路，尤其是在可能产生高膀胱内压的患者群体中。
