Swarnakar Raktim, Yadav Shiv Lal
Faculty of Physical Medicine and Rehabilitation, National Cancer Institute, Jhajjar, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India.
Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India.
World J Clin Cases. 2025 Jul 16;13(20):103729. doi: 10.12998/wjcc.v13.i20.103729.
Clinical bladder evaluation is a cost-effective, non-invasive method for diagnosing and managing urinary dysfunction, particularly in patients with neurogenic bladder or other impairments. This process aims to assess bladder capacity, storage, and voiding functions through simple, realistic, and resource-friendly approaches. It involves a structured series of steps, from history-taking and physical examination to bladder-emptying procedures, monitoring urine leaks, assessing reflex voiding, measuring post-void residual (PVR), and calculating total bladder capacity. These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction, providing critical insights for tailored management. The interpretation of findings focuses on identifying bladder type, assessing leak timing and volume, evaluating reflex voiding, and measuring PVR and total bladder capacity. The results guide interventions such as timing self-clean intermittent catheterization, adjusting fluid intake, and using bladder diaries to monitor patterns. Clinical bladder evaluation is particularly advantageous in low-resource settings, as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively. Despite its benefits, no validation studies currently exist for clinical bladder assessment, and its parameters, like maximum voided volume, remain underexplored compared to urodynamic measures. Given the accessibility, affordability, and practicality of this approach, it holds promise for widespread application, especially in primary care settings and among economically disadvantaged populations. This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.
临床膀胱评估是一种经济高效的非侵入性方法，用于诊断和管理排尿功能障碍，特别是对于神经源性膀胱或其他功能障碍患者。该过程旨在通过简单、实用且资源友好的方法来评估膀胱容量、储尿和排尿功能。它包括一系列结构化步骤，从病史采集和体格检查到膀胱排空程序、监测尿液漏出、评估反射性排尿、测量残余尿量（PVR）以及计算膀胱总容量。这些评估有助于区分上运动神经元和下运动神经元膀胱功能障碍，为个性化管理提供关键见解。对检查结果的解读重点在于确定膀胱类型、评估漏尿时间和量、评估反射性排尿以及测量PVR和膀胱总容量。结果指导诸如确定自我清洁间歇性导尿时间、调整液体摄入量以及使用膀胱日记来监测排尿模式等干预措施。临床膀胱评估在资源匮乏地区尤其具有优势，因为它避免了与尿动力学研究相关的风险和成本，同时更有效地反映了患者的实际情况。尽管有这些优点，但目前尚无针对临床膀胱评估的验证研究，与尿动力学测量相比，其参数（如最大排尿量）仍未得到充分探索。鉴于这种方法的可及性、可承受性和实用性，它有望得到广泛应用，特别是在初级保健环境以及经济弱势人群中。这篇社论逐步描述了该过程，并强调了其在改善患者预后同时将并发症降至最低方面的作用。
