Arlandis Salvador, Vázquez-Costa Juan Francisco, Martínez-Cuenca Esther, Sevilla Teresa, Boronat Francisco, Broseta Enrique
Department of Urology, HUP La Fe, Valencia, Spain.
Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain.
Neurourol Urodyn. 2017 Mar;36(3):626-631. doi: 10.1002/nau.22976. Epub 2016 Feb 19.
To determine lower urinary tract symptoms (LUTS) prevalence and urodynamic findings in amyotrophic lateral sclerosis (ALS) patients treated in our hospital.
Cross-sectional and descriptive study on a cohort of ALS patients. Validated questionnaires (ICIQ-SF, IPSS, and OAB-V8) were self-administered in order to evaluate the presence of LUTS. Symptoms were classified as clinically significant (csLUTS), if any of following scores, IPSS > 7, ICIQ-SF > 0, or OAB-V8 ≥ 8, were present. Urodynamic study was offered to csLUTS patients. Physical examination and prostate ultrasound were also performed.
Fifty five of seventy nine (70%) ALS patients accepted to participate in the study. Only 24/55 (43.6%) patients met criteria for csLUTS and 13 patients reported urgency urinary incontinence (26.3%). Most of csLUTS patients complained of mixed symptoms (82.6%). QoL measured by IPSS was 2.1 ± 1.5, 20% scoring as mostly dissatisfied or unhappy. Average QoL ICIQ-SF scoring was 3.17 ± 3, 33% complained of moderate to severe bother. Ten of twenty four (41.7%) csLUTS patients consented to UDS. The most frequent finding was detrusor overactivity with obstruction due to non-relaxing external sphincter (five patients) or bladder neck (two patients). Two patients showed normal bladder filling but non-relaxing external sphincter during voiding. UDS was normal in one patient.
In this small pilot study we found a high prevalence of csLUTS in ALS which are mainly related to a combination of voiding and storage symptoms. In most patients, symptoms are caused by overactive detrusor combined with non-relaxing sphincter. Severity of symptoms and impact in QoL is only moderate but in a subset of patients can be considerable. Neurourol. Urodynam. 36:626-631, 2017. © 2016 Wiley Periodicals, Inc.
确定在我院接受治疗的肌萎缩侧索硬化症（ALS）患者下尿路症状（LUTS）的患病率及尿动力学检查结果。
对一组ALS患者进行横断面描述性研究。采用经过验证的问卷（ICIQ-SF、IPSS和OAB-V8）进行自我评估，以评估LUTS的存在情况。如果出现以下任何一项评分，即IPSS＞7、ICIQ-SF＞0或OAB-V8≥8，则症状被分类为具有临床意义的LUTS（csLUTS）。为csLUTS患者提供尿动力学检查。同时进行体格检查和前列腺超声检查。
79例ALS患者中有55例（70%）同意参与本研究。只有24/55（43.6%）的患者符合csLUTS标准，13例患者报告有急迫性尿失禁（26.3%）。大多数csLUTS患者主诉混合性症状（82.6%）。通过IPSS测量的生活质量评分为2.1±1.5，20%的患者评分显示大多不满意或不开心。ICIQ-SF的平均生活质量评分为3.17±3，33%的患者主诉有中度至重度困扰。24例csLUTS患者中有10例（41.7%）同意接受尿动力学检查（UDS）。最常见的检查结果是逼尿肌过度活动伴因外括约肌不松弛（5例患者）或膀胱颈（2例患者）导致的梗阻。2例患者膀胱充盈正常，但排尿时外括约肌不松弛。1例患者UDS结果正常。
在这项小型初步研究中，我们发现ALS患者中csLUTS的患病率较高，主要与排尿和储尿症状的组合有关。在大多数患者中，症状是由逼尿肌过度活动合并括约肌不松弛引起的。症状的严重程度和对生活质量的影响仅为中度，但在一部分患者中可能相当严重。《神经泌尿学与尿动力学》36:626 - 631，2017年。©2016威利期刊公司
