187 例帕金森病患者排尿功能障碍的评估和管理。

Assessment and Management of Urinary Dysfunction in 187 Patients with Parkinson's Disease.

机构信息

Department of Urology, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.

Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

出版信息

J Parkinsons Dis. 2020;10(3):993-1001. doi: 10.3233/JPD-191806.

DOI:10.3233/JPD-191806

PMID:32310185

Abstract

BACKGROUND

Urinary dysfunction is common in Parkinson's disease (PD) patients and management options are limited.

OBJECTIVE

This study aimed to explore the management of urinary dysfunction by researching the special needs of PD patients.

METHODS

PD patients with urinary dysfunction who underwent urodynamic testing were recruited from a single center from October 2013 to February 2019. The urinary symptoms, International Prostate Symptom Score and Hoehn-Yahr scale were evaluated. Management was made at the urologists' discretion with follow-up after three weeks. Urinary symptoms, urodynamics and the management of urinary dysfunction were analyzed.

RESULTS

A total of 187 patients with a median age of 66.2 and Hoehn-Yahr scale soccer of 2 were enrolled. Irritative symptoms were more common than obstructive symptoms, while obstructive symptoms were more common in male than female patients, except for incomplete voiding. There were 51% cases of detrusor overactivity, followed by 33% with bladder outlet obstruction, 13% had normal function, 12% had detrusor underactivity, 9% had stress incontinence, 7% had increased bladder sensation and 4% had an acontractile bladder. Tolterodine and tamsulosin were the most common therapeutic agents, respectively prescribed to 38.5% and 27.3% of the patients. Other treatments included catheterization, botulinum toxin A bladder wall injection, transurethral resection of the prostate and urethral dilatation. Urinary symptoms were improved significantly in 74.5% of the patients (p < 0.001), including 27 patients treated with tamsulosin only and 54 patients with tolterodine only.

CONCLUSIONS

Urinary symptoms and urodynamics were highly variable in PD patients, indicating that most patients may benefit from personalized management.

摘要

背景

尿失禁是帕金森病（PD）患者的常见问题，且治疗选择有限。

目的

本研究旨在通过研究 PD 患者的特殊需求，探讨尿失禁的管理方法。

方法

从 2013 年 10 月至 2019 年 2 月，我们在单中心招募了接受尿动力学检查的 PD 合并尿失禁患者。评估患者的尿症状、国际前列腺症状评分（IPSS）和 Hoehn-Yahr 分级。治疗方案由泌尿科医生决定，并在 3 周后进行随访。分析患者的尿症状、尿动力学和尿失禁的治疗情况。

结果

共纳入 187 例患者，中位年龄 66.2 岁，Hoehn-Yahr 分级为 2 级。以刺激症状更为常见，而男性患者的梗阻症状比女性更为常见，除了排尿不净。逼尿肌过度活动占 51%，其次是膀胱出口梗阻占 33%、膀胱功能正常占 13%、逼尿肌收缩力低下占 12%、压力性尿失禁占 9%、膀胱感觉过敏占 7%、无收缩性膀胱占 4%。托特罗定和坦索罗辛是最常用的治疗药物，分别有 38.5%和 27.3%的患者使用。其他治疗方法包括导尿、肉毒毒素 A 膀胱壁注射、经尿道前列腺切除术和尿道扩张术。74.5%的患者（p<0.001）尿症状得到显著改善，其中 27 例仅接受坦索罗辛治疗，54 例仅接受托特罗定治疗。