Kerdraon J, Peyronnet B, Gamé X, Fatton B, Haddad R, Hentzen C, Jeandel C, Mares P, Mezzadri M, Petit A-C, Robain G, Vetel J-M, Amarenco G
Centre mutualiste de rééducation et réadaptation Kerpape, BP 78, 56275 Ploemeur cedex, France.
Service d'urologie, CHU de Rennes, 35000 Rennes, France.
Prog Urol. 2017 Jun;27(7):402-412. doi: 10.1016/j.purol.2017.04.005. Epub 2017 May 23.
The aim of this study was to review the evidence regarding the pathophysiology of detrusor underactivity in the elderly.
A literature review was conducted in July 2016 using the Medline/Pubmed database limiting the search to works in English or French.
The prevalence of detrusor underactivity has been reported to range from 8% to 48% depending on the definition used and the age of the population studied. Current data suggest that aging may itself be a causative factor of detrusor underactivity through myogenic dysfunctions (ultrastructural degeneration of the detrusor muscle) and neurogenic dysfunctions (by degeneration of efferent but mostly afferent innervation mechanisms). Beyond these inherently age-related mechanisms, many comorbidities whose prevalence increase with age (diabetes, bladder outlet obstruction, estrogen deficiency, atherosclerosis, etc.) may be implicated in the development of detrusor underactivity in the elderly. The role played by detrusor overactivity in the appearance of detrusor underactivity must be considered separately as both seem to be the expression of the same condition of the lower urinary tract responding to different stages and secondary to numerous etiopathogenic factors which modulate its progression and clinical expressions.
Pathophysiology of detrusor underactivity remains poorly understood but seems to imply myogenic and neurogenic factors which are favored, besides the aging per se, by various and numerous comorbidities which prevalence increase with age (diabetes, bladder outlet obstruction…).
本研究旨在综述关于老年人逼尿肌活动低下病理生理学的证据。
2016年7月使用Medline/Pubmed数据库进行文献综述，搜索限于英文或法文文献。
根据所采用的定义及所研究人群的年龄，逼尿肌活动低下的患病率据报道在8%至48%之间。目前的数据表明，衰老本身可能是逼尿肌活动低下的一个致病因素，其通过肌源性功能障碍（逼尿肌超微结构退变）和神经源性功能障碍（通过传出神经尤其是传入神经支配机制的退变）导致。除了这些与年龄相关的内在机制外，许多随着年龄增长患病率增加的合并症（糖尿病、膀胱出口梗阻、雌激素缺乏、动脉粥样硬化等）可能与老年人逼尿肌活动低下的发生有关。逼尿肌活动亢进在逼尿肌活动低下出现中所起的作用必须单独考虑，因为两者似乎都是下尿路同一状况在不同阶段的表现，且继发于众多调节其进展和临床表现的病因学因素。
逼尿肌活动低下的病理生理学仍知之甚少，但似乎涉及肌源性和神经源性因素，除衰老本身外，各种随着年龄增长患病率增加的合并症（糖尿病、膀胱出口梗阻……）也有利于这些因素的产生。
