Im Young Jae, Lee Jung Keun, Park Kwanjin
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Seoul National University Children's Hospital, Seoul, Korea.
Int Neurourol J. 2018 Jun;22(2):107-113. doi: 10.5213/inj.1836020.010. Epub 2018 Jun 30.
To characterize the course of treatment for nonmonosymptomatic enuresis with overactive bladder (OAB) in a real clinical setting.
Data from 111 OAB patients with moderate to severe enuresis were analyzed. The baseline analysis included a questionnaire, voiding diary, uroflowmetry with postvoid residual urine measurement, and plain abdominal radiography of the kidneys, ureters, and bladder (KUB). Following standard urotherapy for 1 month, anticholinergic medication was administered with or without laxatives. Desmopressin was added if there was a partial response to OAB. Patients were followed every 3 months to evaluate the status of OAB and enuresis. Multivariate analysis was performed to identify predictors associated with the lack of complete response (CR) in enuresis at 12 months.
Following 12 months of treatment, 64% and 88% of patients experienced at least partial response in enuresis and OAB, respectively. Urgency improved more quickly than enuresis, supporting the need to address daytime symptoms before enuresis. Seventy-nine patients (71%) had fecal impaction on KUB and/or subjective constipation. The combination of anticholinergics with either laxatives or desmopressin fared better than anticholinergics alone. Daytime incontinence and anticholinergics- only treatment were associated with a lack of CR during 12 months of treatment.
The data confirmed the validity of addressing OAB before treating enuresis. The results of this study also highlight the need to address fecal impaction. Patients should be counseled about the need for a prolonged course of treatment before starting treatment. Anticholinergics should be accompanied with either desmopressin or laxatives for better control of enuresis.
在真实临床环境中描述伴膀胱过度活动症（OAB）的非单症状性遗尿症的治疗过程。
分析了111例中重度遗尿症的OAB患者的数据。基线分析包括一份问卷、排尿日记、排尿后残余尿量测量的尿流率测定以及肾脏、输尿管和膀胱的腹部平片（KUB）。在进行1个月的标准尿疗法后，给予抗胆碱能药物，可联合或不联合使用泻药。如果对OAB有部分反应，则加用去氨加压素。每3个月对患者进行随访，以评估OAB和遗尿症的状况。进行多变量分析以确定与12个月时遗尿症缺乏完全缓解（CR）相关的预测因素。
治疗12个月后，分别有64%和88%的患者遗尿症和OAB至少有部分缓解。尿急症状比遗尿症改善得更快，这支持了在治疗遗尿症之前先解决日间症状的必要性。79例患者（71%）在KUB检查中发现有粪嵌塞和/或有主观便秘症状。抗胆碱能药物与泻药或去氨加压素联合使用的效果优于单独使用抗胆碱能药物。日间尿失禁和仅使用抗胆碱能药物治疗与治疗12个月期间缺乏CR相关。
数据证实了在治疗遗尿症之前先治疗OAB的有效性。本研究结果还强调了处理粪嵌塞的必要性。在开始治疗前，应向患者说明需要进行长期治疗。抗胆碱能药物应与去氨加压素或泻药联合使用，以更好地控制遗尿症。
