神經性排尿障礙之發生及其診治

Pathogenesis, Diagnosis, and Management of Neurogenic Voiding Dysfunction

盧星華(Shing-Hwa Lu)

《北市醫學雜誌》 2卷11期 (2005/11) Pp. 974-981

https://doi.org/10.6200/TCMJ.2005.2.11.01

摘要

神經性排尿障礙(neurogenic voiding dysfunction)是泌尿科醫師及病人最感困擾的問題之一。其最常見的尿路症狀包括排尿困難、餘尿量過多，及尿滯留(urinary retention)的問題。此外尿失禁的問題也常令病人感到困擾，包括急迫性尿失禁、滿溢性尿失禁、甚或是應力性尿失禁。由於排尿後餘尿量過高，復加以排尿時膀胱內壓力較高的結果，易導致尿路感染(urinary tract infection)，膀胱輸尿管尿液逆流(vesicoureteral reflux)，腎及輸尿管水腫（hydronephrosis及hydroureter），腎功能缺損，腎臟結疤，腎臟萎縮，最後甚至腎功能衰竭，進而產生更多的併發症。神經性排尿障礙的患者將呈現不隨意的反射性排尿情形。治療的目標在於將此種不隨意的反射性排尿轉換為較合乎自然的隨意排尿控制，例如：藉由降低逼尿肌活性、增加膀胱容積及調控膀胱出口阻力以改善逼尿肌過度活動及尿道閉合之功能。治療的原則包括：（一）保護腎功能；（二）控制泌尿道感染；（三）儲尿及排尿時維持膀胱低壓力；（四）促進其社交功能。

關鍵字

尿失禁 ； 逼尿肌過度活動 ； 神經性膀胱

並列摘要

Neurogenic voiding dysfunction is one of the most bothersome problems for urologists and patients. The most common urinary tract symptoms are voiding difficulty, increased residual urine, and urinary retention. Urinary incontinence is also common for the patients including urge, overflow, and stress urinary incontinence. Increase of post-void residual urine amount and high intravesical pressure during voiding can cause subsequent urinary tract infection, vesicoureteral reflux, hydronephrosis, impaired renal function, renal scarring, renal atrophy, renal failure and other complications. Involuntary voiding reflex may occur in patients with neurogenic voiding dysfunction. The aim of the management of neurogenic voiding dysfunction is to convert the involuntary voiding reflex into voluntary voiding control by decreasing detrusor activity, increasing bladder capacity and modulating bladder outlet resistance. The principles of management are as follows: (1) protection of renal function; (2) control of urinary tract infection; (3) maintenance of low intravesical pressure during bladder storage and voiding phases; (4) improvement of the social function.

並列關鍵字

urinary incontinence ； detrusor hyperreflexia ； neurogenic bladder