Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom.
Semin Neurol. 2020 Oct;40(5):569-579. doi: 10.1055/s-0040-1713876. Epub 2020 Oct 16.
Lower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.
下尿路功能障碍是一种常见的神经病变后遗症，其症状严重影响生活质量。神经病变的部位和性质影响功能障碍的模式。与脊髓损伤或脊柱裂患者相比，患有缓慢进展性非创伤性神经疾病的患者发生上尿路损伤和肾衰竭的风险要低得多。在制定适当的管理算法时，会考虑到这种发病率的明显差异。初步评估包括病史采集、膀胱日记，根据临床指征，还可以补充尿流率、残余尿量测量、肾脏超声、（视频）尿动力学、神经生理学和尿道膀胱镜检查等检查。不完全排空膀胱通常采用间歇性导尿，储存功能障碍采用抗胆碱能药物治疗。膀胱内注射肉毒毒素 A 已彻底改变了神经源性逼尿肌过度活动症的治疗方法。神经调节为治疗储尿和排尿功能障碍提供了希望。对于某些患者，可能需要进行重建性泌尿外科手术。对于这一特殊人群的下尿路功能障碍，需要采用个体化、针对患者的治疗方法。
