Marinkovic Serge P
Department of Urology, Detroit Medical Center, Harper Hospital, 39990 John R, Detroit, MI 48201, USA.
Ther Adv Urol. 2019 Apr 25;11:1756287219844669. doi: 10.1177/1756287219844669. eCollection 2019 Jan-Dec.
Overactive bladder is characterized by frequency, urgency (wet or dry) and nocturia. These troublesome symptoms incur both a physiologic and economic cost, expected to be in excess of US$82 billion in the USA and Europe by the year 2020. Second-tier medicinal oral therapies for overactive bladder abound, but the failure rate or discontinuation at 1 year exceeds 50%. Tertiary-tier therapies involve surgical alternatives including neuromodulation of sacral nerve 3 (S) or the posterior tibial nerve as a means to manipulate and ameliorate the above-described voiding symptoms. Sacral neuromodulation has been studied for more than 20 years, but newer, smaller, rechargeable implantable devices are in the forefront of current investigation. Hopes are that modifications to the device will eventually be possible at the patient's home, rather than the physician's office, with close urological/gynecologic supervision and guidance. Another means of surgical intervention for overactive bladder includes the use of a cystoscopy-guided radiofrequency probe by which energy disrupts the bladder floor neural voiding plexi. Stem cell therapy is also being evaluated for overactive bladder but is in the early stages of development.
膀胱过度活动症的特征是尿频、尿急（无论是否伴有尿失禁）和夜尿症。这些令人困扰的症状会产生生理和经济成本，预计到2020年，美国和欧洲的这一成本将超过820亿美元。治疗膀胱过度活动症的二线口服药物疗法很多，但一年后的失败率或停药率超过50%。三线疗法包括手术替代方案，如对骶神经3（S3）或胫后神经进行神经调节，以此来控制和改善上述排尿症状。骶神经调节已经研究了20多年，但更新、更小、可充电的植入式设备是当前研究的前沿。人们希望最终可以在患者家中而非医生办公室对设备进行调整，同时接受泌尿外科/妇科医生的密切监督和指导。另一种针对膀胱过度活动症的手术干预方法是使用膀胱镜引导的射频探头，通过能量破坏膀胱底部的神经排尿丛。干细胞疗法也正在针对膀胱过度活动症进行评估，但尚处于开发的早期阶段。
