Effect of Individualized Bladder Rehabilitation Program in Patients with Neurogenic Lower Urinary Tract Dysfunction, a Pilot Study

神經性下尿路功能障礙病人經個人化膀胱復健後效果之先導性研究

王培任(Peir-Renn Wang) ； 王偉哲(Wei-Che Wang) ； 陳順郎(Sung-Lang Chen) ； 黃玉慧(Yu-Hui Huang) ； 賴郁芬(Yu-Fen Lai) ； 楊琇君(Hsiu-Chun Yang)

《台灣復健醫學雜誌》 43卷2期 (2015/06) Pp. 111-120

https://doi.org/10.6315/2015.43(2)05

摘要

目的：神經性下尿路障礙（NLUTD）是脊髓損傷後常見的後遺症和致病或致死的主要原因之一。目前治療神經性膀胱的方式包括藥物，非侵襲性保守治療，微創治療及手術治療。然而，目前並沒有研究討論針對綜合骨盆底肌肉運動（PFM exercise）及電刺激（ES）的非侵襲性保守治療。這研究主要是針對脊髓損傷伴隨有神經性下尿路障礙（NLUTD）的病人，提供個人化膀胱復健治療，給予包括排尿行為指導，骨盆底肌肉運動並合併肌電圖生理回饋及電刺激（抑制膀胱或強化骨盆底肌肉）治療之後再評估其成效。方法：提供薦髓上不完全脊髓損傷或馬尾束症候群之患者兩個月個人化膀胱復健治療，並在治療前後以解尿後殘尿量和包括國際前列腺症狀積分（IPSS），膀胱過動症問卷（OABSS），尿失禁症狀困擾量表（UDI-6），尿失禁生活衝擊量表（ⅡQ-7）等問卷加以評估效果。結果：在治療後，包括解尿後殘尿量，國際前列腺症狀積分中之失禁症狀和生活品質分量表，膀胱過動症問卷，尿失禁症狀困擾量表，尿失禁生活衝擊量表等問卷分數皆顯著下降，代表其生活品質及症狀有改善。不過，國際前列腺症狀積分中之阻塞症狀分量表和總症狀量表分數，在治療前後並未看到顯著差異。結論：有神經性下尿路障礙的病人在接受包括衛教，骨盆底肌肉運動並合併肌電圖生理回饋及電刺激（抑制膀胱或強化骨盆底肌肉）等個人化膀胱復健治療後將會有所助益。經過此種治療之病人，其解尿後殘尿量及因失禁而受影響之生活品質將因之改善。

關鍵字

脊髓損傷（SCI） ； 神經性下尿路障礙（NLUTD） ； 膀胱復健 ； 骨盆底肌肉運動 ； 電刺激（ES）

並列摘要

Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the major sequelae after spinal cord injury (SCI) and a cause of increased morbidity and mortality in SCI patients. Current treatment strategies for NLUTD include medication, non-invasive conservative management, minimally invasive therapy, and surgical intervention. However, there are no studies regarding non-invasive conservative management that combines pelvic floor muscle (PFM) exercises and electrical stimulation (ES). This study was designed to evaluate the efficacy of individualized bladder rehabilitation programs, which included education on voiding behavior, PFM exercise training combined with electromyography (EMG) biofeedback, and ES (for bladder inhibition or PFM strengthening), in SCI patients with NLUTD. Methods: Individualized bladder rehabilitation programs were provided for 2 months for patients with incomplete SCI at the suprasacral level or cauda equina syndrome. The patients were evaluated using post-voiding residual urine (PVR) amounts and the questionnaires of the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7). Results: After the individualized bladder rehabilitation programs, the post-voiding residual urine amounts; OABSS, UDI-6, and IIQ-7 scores; and subtotal incontinence score and quality of life (QOL) scores of the IPSS all decreased significantly. These results indicate an improved quality of life and fewer symptoms. However, the changes in the subtotal obstruction score and the total symptom score of the IPSS were not significant. Conclusion: Selected SCI patients with NLUTD could benefit from individualized bladder rehabilitation programs, which include education on voiding behavior, PFM exercises combined with EMG biofeedback, and ES for bladder inhibition or PFM strengthening. Patients who received bladder rehabilitation programs obtained beneficial effects on reducing PVR amounts and QOL scores related to incontinence.

並列關鍵字

Spinal cord injury ； Neurogenic lower urinary tract dysfunction ； Bladder rehabilitation ； Pelvic floor muscle exercise ； Electrical stimulation

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