<br>膀胱功能低下尿失禁的治疗：综述。,International Neurourology Journal

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膀胱功能低下尿失禁的治疗：综述。
International Neurourology Journal ( IF 1.8 ) Pub Date : 2020-06-30 , DOI: 10.5213/inj.2040076.038
Kang Jun Cho ₁ , Joon Chul Kim ₁

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尿失禁是由储存功能衰竭引起的，而膀胱活动不足（UAB）是由逼尿肌收缩力下降和排尿功能障碍引起的。由于失禁和UAB的治疗机制是相反的，因此很难同时治疗失禁和UAB，并且会进一步降低患者的生活质量。传统的尿道中段吊带 (MUS)，例如经闭孔吊带或耻骨后 MUS，在 UAB 压力性尿失禁中存在术后排尿功能障碍的风险。然而，已有一些关于传统 MUS 的有效性和安全性的报道。可调节吊带手术，例如经闭孔可调节胶带或 Remeex 系统，比传统 MUS 具有更好的效果，因为它们可以在手术期间和手术后控制张力。当尿失禁治疗后出现排尿功能障碍时，可以通过多种治疗方式改善排尿症状。对于排尿后残余量显着增加或尿潴留的患者，建议进行清洁间歇导尿。尽管可以考虑使用α受体阻滞剂或拟副交感神经药等药物治疗 UAB，但没有足够的证据表明它们对 UAB 失禁的效果。未来的疗法，例如干细胞疗法或基因疗法，可用于治疗 UAB 尿失禁。有人建议使用骶神经调节来治疗与逼尿肌过度活跃和收缩力受损相关的急迫性尿失禁。需要进一步的研究来证实 UAB 失禁治疗的有效性和安全性并改善患者的生活质量。

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Management of Urinary Incontinence With Underactive Bladder: A Review.

Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient's quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.

更新日期：2020-08-21

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