Shimizu K, Yasukawa M, Yamamoto M, Hirao Y, Momose H, Kashiwai H, Kawata Y, Yamada K
Department of Urology, Nara Medical University.
Hinyokika Kiyo. 1997 Nov;43(11):765-9.
Clinical symptoms, urodynamic findings, and urological treatment of 35 patients with neurogenic bladder dysfunction caused by Parkinson's disease (11 patients), multiple sclerosis (10 patients), and spinocerebellar degeneration (14 patients) were reviewed retrospectively. Most of the patients had a relatively low stage of disease, when they were first seen by their urologists. Chief urological complaints were of irritation in 63.6% of Parkinson's disease and 64.3% of spinocerebellar degeneration cases, compared with obstruction in 80.0% of multiple sclerosis cases. Cystometry revealed underactive detrusor function in 69.2% of the patients with spinocerebellar degeneration but no abnormalities in the patients with Parkinson's disease or multiple sclerosis. Of 34 patients, excluding one patient lost to follow-up, the period of urological management ranged from one to 44 weeks with a mean of 11.0. The final methods of urinary drainage in 34 patients consisted of voluntary voiding in 20, clean intermittent catheterization in 11 including eight by self catheterization, incontinence into diaper in two, and indwelling catheter in one. Five patients were compelled to change urinary drainage method from voluntary voiding to clean intermittent catheterization because of increasing residual volume in four and progressing bladder deformity in one. However, none of them showed the clinical signs of primary disease progression. These findings indicate that in patients with Parkinson's disease, multiple sclerosis, and spinocerebellar degeneration, the urological symptoms can appear even in the early stage of disease. In addition, close follow-up is important in the urological management of neurogenic bladder patients with these diseases, because the disorders of the lower urinary tract may progress regardless of the status of the primary disease.
对35例由帕金森病（11例）、多发性硬化症（10例）和脊髓小脑变性（14例）引起的神经源性膀胱功能障碍患者的临床症状、尿动力学检查结果及泌尿外科治疗进行了回顾性分析。大多数患者在初次就诊于泌尿外科医生时疾病分期相对较低。主要的泌尿外科主诉方面，帕金森病患者中有63.6%、脊髓小脑变性患者中有64.3%表现为刺激症状，而多发性硬化症患者中有80.0%表现为梗阻症状。膀胱测压显示，脊髓小脑变性患者中有69.2%存在逼尿肌功能低下，而帕金森病或多发性硬化症患者未发现异常。34例患者（排除1例失访患者）的泌尿外科治疗时间为1至44周，平均为11.0周。34例患者最终的尿液引流方法包括：20例自主排尿，11例清洁间歇性导尿（其中8例为自行导尿），2例使用尿垫失禁护理，1例留置导尿。5例患者因残余尿量增加（4例）或膀胱畸形进展（1例）而被迫将尿液引流方法从自主排尿改为清洁间歇性导尿。然而，他们均未出现原发性疾病进展的临床征象。这些发现表明，在帕金森病、多发性硬化症和脊髓小脑变性患者中，泌尿外科症状甚至可在疾病早期出现。此外，对于患有这些疾病的神经源性膀胱患者，密切随访在泌尿外科管理中很重要，因为下尿路疾病可能无论原发性疾病状况如何都会进展。
