Tudor Katarina Ivana, Sakakibara Ryuji, Panicker Jalesh N
Department of Neurology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia.
Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
J Neurol. 2016 Dec;263(12):2555-2564. doi: 10.1007/s00415-016-8212-2. Epub 2016 Jul 11.
The lower urinary tract (LUT) in health is regulated by coordinated multi-level neurological inputs which require an intact central and peripheral nervous system. Lower urinary tract dysfunction is, therefore, a common sequelae of neurological disease and the patterns of bladder storage and voiding dysfunction depend upon the level of neurological lesion. Evaluation includes history taking, bladder diary, urological examination when relevant, ultrasonography and urodynamic testing when indicated. Antimuscarinic agents are the first line treatment for patients with storage dysfunction. Alternative treatments include intradetrusor injection of onabotulinumtoxinA, which has been shown to be of benefit in patients with neurogenic detrusor overactivity (NDO), and neuromodulation. Intermittent catheterization remains the option of choice in patients with significant voiding dysfunction resulting in high post-void residual volumes.
健康状态下的下尿路（LUT）受多级神经输入的协调调控，这需要完整的中枢和外周神经系统。因此，下尿路功能障碍是神经疾病的常见后遗症，膀胱储尿和排尿功能障碍的模式取决于神经损伤的程度。评估包括病史采集、膀胱日记、必要时的泌尿外科检查、超声检查以及必要时的尿动力学检测。抗毒蕈碱药物是储尿功能障碍患者的一线治疗药物。其他治疗方法包括膀胱逼尿肌内注射A型肉毒毒素，已证明其对神经源性逼尿肌过度活动（NDO）患者有益，以及神经调节。对于因排尿功能严重障碍导致大量残余尿量的患者，间歇性导尿仍是首选方法。
