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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 周永強 翁竹浩 |
Differential Diagnosis of Overactive Bladder in Men | 2010/1/28 下午 03:29:55 | 0 |
| 原 文 | 題 目 | Differential Diagnosis of Overactive Bladder in Men |
| 作 者 | Jerry G. Blaivas, Brian K. Marks, Jeffrey P. Weiss, Georgia Panagopoulos | |
| 出 處 | The Journal of Urology | |
| 出版日期 | December 2009 (Vol. 182, 2814-2818) | |
| 評 論 |
將近有9%至16%的成人具有過動性膀胱(Overactive Bladder, OAB)的問題。根據國際尿控協會(International Continence Society)將過動性膀胱定義為：不論是否合併尿失禁的急尿症狀，時常伴隨頻尿與夜尿，同時必須排除感染或是其他可以被證實的病因。作者評估了經問卷篩選為符合過動性膀胱症狀的男性共122位(平均年齡為70歲)，並試圖決定同時伴隨的病生理異常的鑑別診斷。 結果在納入研究的122名男性中，有70位經過尿路動力學測試出具有逼尿肌過度活動，56位被診斷出良性攝護腺肥大，其中40位是有症狀而不具其他病因，13位診斷為神經性膀胱，27位被診斷為膀胱出口阻塞，25位病人為攝護腺癌治療過後的併發症，7位為尿道狹窄，而特發性的過動性膀胱只有6 位。作者認為，符合過動性膀胱定義之病患常常同時具有其他疾病。根據本研究32%的病患應被診斷為良性攝護腺肥大，22%應被診斷為膀胱出口阻塞，20%則為攝護腺癌治療過後所產生的併發症，真正應被定義為過動性膀胱的患者只佔5%。臨床醫師應考慮對被診斷為過動性膀胱的病患做更詳細的鑑別診斷。如此，可針對病患個別問題作更加精確的治療以改善病人的症狀，更能使治療的成功率增加。 當然本篇也有一些限制，研究的病患樣本數過少，以及病患因都為求診泌尿科醫師之病患，以及平均年齡層較大，無法充分代表整個男性族群。不過藉由此研究提醒我們應當更加注意過動性膀胱背後所引起的病因，提供對病患更好的治療。 |
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| abstract |
Purpose: We determined the differential diagnosis of concomitant pathological conditions in men with overactive bladder symptoms. Materials and Methods: We performed an observational, descriptive study to elucidate the differential diagnosis in men with overactive bladder symptoms using a previously validated overactive bladder symptom questionnaire. All patients provided an extensive history, completed the self-administered questionnaire and a 24-hour voiding diary, and underwent physical examination, 24-hour pad test, uroflowmetry, post-void residual urine measurement, cystoscopy and urodynamics. Selection criteria were developed to assign cases to a category, including idiopathic overactive bladder, benign prostatic enlargement, benign prostatic obstruction, neurogenic bladder, bladder cancer, prostate cancer treatment complications, urethral stricture, bladder stones and bladder diverticulum. Results: Of 122 men who met ion criteria for overactive bladder detrusor overactivity was identified in 99 (79%) on urodynamics. The differential diagnosis was benign prostatic enlargement in 40 men (32%), benign prostatic obstruction in 27 (22%), complications of prostate cancer treatment in 25 (20%), neurogenic bladder in 13 (11%), urethral stricture in 7 (6%), idiopathic overactive bladder in 6 (5%), bladder stone in 2 (2%), bladder cancer in 1 (1%) and bladder diverticulum in 1 (1%). Conclusions: Overactive bladder is a complex diagnosis with many underlying, contributing urological pathologies. It should be considered a symptom complex and not a syndrome. Knowledge of the differential diagnosis in men with overactive bladder symptoms would hopefully provide clinicians with a diagnostic rubric to more specifically treat such patients with improved success. |
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