Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan.
Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan; School of Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
J Formos Med Assoc. 2018 Mar;117(3):178-184. doi: 10.1016/j.jfma.2017.09.006. Epub 2017 Sep 30.
In clinical practice, many patients cannot empty their bladders within an acceptable duration. Common complaints include weak urinary stream and incomplete emptying, which may affect quality of life. Bladder emptying requires sufficient detrusor contractile power, velocity, and durability. The urodynamic term for inadequate detrusor contraction is detrusor underactivity (DU). Although this definition was provided by the ICS, it may not be clinically practical. Analogous to the relationship between overactive bladder (OAB) and detrusor overactivity (DO), the symptom complex caused by DU is termed underactive bladder (UAB). Many conditions lead to UAB, such as advanced age, neurogenic bladder and BOO, but the definite pathophysiology directly leading to UAB is still being widely studied without a widely-accepted consensus. The preferred mainstream treatment for increased residual urine volume caused by UAB is intermittent catheterization, while pharmacotherapy is still disappointing after decades of development. There are no studies on surgical treatment for UAB with an acceptable level of evidence. We reviewed the recent literature on UAB and DU to provide a comprehensive discussion of the related presentation, etiology, diagnosis and management.
在临床实践中，许多患者无法在可接受的时间内排空膀胱。常见的抱怨包括尿流弱和排空不完全，这可能会影响生活质量。膀胱排空需要足够的逼尿肌收缩力、速度和耐久性。逼尿肌收缩不足的尿动力学术语为逼尿肌活动低下（DU）。尽管这一定义是由国际尿控协会提供的，但在临床上可能并不实用。类似于膀胱过度活动症（OAB）和逼尿肌过度活动（DO）之间的关系，由 DU 引起的症状复杂称为膀胱活动低下（UAB）。许多情况会导致 UAB，如年龄增长、神经性膀胱和 BOO，但直接导致 UAB 的明确病理生理学仍在广泛研究中，尚未达成广泛接受的共识。对于 UAB 引起的残余尿量增加，首选的主流治疗方法是间歇性导尿，而经过几十年的发展，药物治疗仍然令人失望。对于 UAB，尚无具有可接受证据水平的手术治疗研究。我们回顾了 UAB 和 DU 的最新文献，对相关表现、病因、诊断和治疗进行了全面讨论。
