Medical Treatment of Neurogenic Voiding Dysfunction

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

The medical management of neurogenic voiding dysfunction is pain on the neck for urological physician. Most of the patients with neurogenic voiding dysfunction suffered from voiding difficulty, urinary incontinence, and subsequent urinary tract infection, vesico-ureteral reflux, hydroureter, hydronephrosis, impaired renal function, and renal failure. Increase of intravesical pressure would be the cause of vesico-ureteral reflux, hydronephrosis, and inpaired renal function. The principal causes of urinary incontinence in patients with neurogenic bladder are detrusor hyperreflexia (DH) and/or incompetence of urethral closing function. Thus, to improve urinary incontinence the treatment should aim at decreasing detrusor activity, increasing bladder capacity and/or increasing bladder outlet resistance. Pharmacologic therapy has been particularly helpful in patients with relatively mild degrees of neurogenic bladder dysfunction. Patients with more profound neurogenic bladder disturbances may require pharmacologic treatment to augment other forms of management such as intermittent catheterization. The two most commonly used classes of agents are anticholinergics and alpha-adrenergic blockers (Table 1). Intravesical pharmacological therapy will be discussed in the following chapter.

並列關鍵字

urinary incontinence ； detrusor hyperreflexia ； neurogenic bladder

國際替代計量

Medical Treatment of Neurogenic Voiding Dysfunction

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