Wang Tao, Huang Wei, Zhang Yong
Department of Urology, Neurourology Research Division, Beijing Tian Tan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Disease, Beijing 100050, China.
Chin Med J (Engl). 2016 Mar 20;129(6):645-50. doi: 10.4103/0366-6999.177970.
Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis (MS). Although the significance of identifying and treating urinary symptoms in MS is currently well-known, there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS. The purpose of this study was to analyze the major symptoms and urodynamic abnormalities, and observe the therapeutic effect in different MS characteristics.
We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital, Capital Medical University and conducted overactive bladder system score (OABSS), urodynamic investigation, and expanded disability status scale (EDSS). Changes of urinary symptoms and urodynamic parameters were investigated.
Urgency was the predominant urinary symptom, and detrusor overactivity was the major bladder dysfunction. There was a positive correlation between EDSS and OABSS. Clinically isolated syndrome (CIS) had lowest EDSS and OABSS. CIS exhibited significant improvements in OABSS, maximum urinary flow rate (Qmax), and bladder volume at the first desire to voiding and maximum bladder volume after the treatment (P < 0.05). Relapsing-remitting MS showed significant improvements in the OABSS, Qmax, and bladder volume at the first desire to voiding, maximum bladder volume and bladder compliance after the treatment (P < 0.05). Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding, the detrusor pressure at maximum flow rate (PdetQmax), and bladder compliance after the treatment (P < 0.05).
Urodynamic parameters examined are important in providing an accurate diagnosis, guiding management decisions of MS. Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.
下尿路功能障碍和泌尿系统症状在多发性硬化症（MS）患者中普遍存在。尽管目前已充分认识到在MS中识别和治疗泌尿系统症状的重要性，但关于MS患者泌尿系统症状的实际患病率和治疗效果尚无相关信息。本研究的目的是分析主要症状和尿动力学异常情况，并观察不同MS特征下的治疗效果。
我们纳入了2008年7月至2015年1月期间在北京天坛医院（首都医科大学附属）招募的126例存在泌尿系统功能障碍的患者，进行膀胱过度活动症系统评分（OABSS）、尿动力学检查以及扩展残疾状态量表（EDSS）评估。研究泌尿系统症状和尿动力学参数的变化。
尿急是主要的泌尿系统症状，逼尿肌过度活动是主要的膀胱功能障碍。EDSS与OABSS之间存在正相关。临床孤立综合征（CIS）的EDSS和OABSS最低。CIS在治疗后OABSS、最大尿流率（Qmax）、首次排尿意愿时的膀胱容量和最大膀胱容量均有显著改善（P < 0.05）。复发缓解型MS在治疗后OABSS、Qmax、首次排尿意愿时的膀胱容量、最大膀胱容量和膀胱顺应性均有显著改善（P < 0.05）。进展型MS在治疗后首次排尿意愿时的膀胱容量、最大尿流率时的逼尿肌压力（PdetQmax）和膀胱顺应性均显著增加（P < 0.05）。
所检查的尿动力学参数对于准确诊断、指导MS的管理决策具有重要意义。早期有效的治疗可能改善MS早期阶段的膀胱功能和生活质量。
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