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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 彭崇信 | 異常功能性排尿 | 2016/3/31 下午 08:50:21 | 0 |
| 原 文 | 題 目 | Dysfunctional voiding |
| 作 者 | Walter Artibani and Maria A. Cerruto | |
| 出 處 | Current Opinion in Urology | |
| 出版日期 | July 2014, 24:330–335 | |
| 評 論 |
這是一篇對於異常功能性排尿(dysfunctional voiding, DV)及女性膀胱出口阻塞(bladder outlet obstruction)的文獻回顧。女性膀胱出口阻塞的病因大致可分為解剖性及功能性兩個範疇。解剖性因素有骨盆器官脫垂(pelvic organ prolapse)、應力性失禁手術、尿道狹窄、尿道憩室及腫瘤等，而功能性因素則包括膀胱頸阻塞(primary bladder neck obstruction, PBNO)、逼尿肌括約肌共濟失調(detrusor sphincter dyssynergia, DSD)、及DV等。DV的定義為：排尿過程中呈現間斷或起伏的尿流，起因於尿道括約肌或週圍橫紋肌的不自主間歇性收縮，而病患本身為神經學正常。診斷時必須排除任何的神經學病變，如發生於多發性硬化(multiple sclerosis)病患的DSD。而逼尿肌活性低下者以腹壓排尿時，尿道括約肌產生的守衛動作(guarding)，也需加以鑑別。錄影尿路動力學檢查及肌電圖是目前最重要的診斷工具，但還沒有公認的診斷標準。在過去文獻中，DV大多被討論於兒童的排尿障礙。發病機轉，認為是一種對於年幼時不良因素如尿路感染、發炎、創傷、或刺激等的反應，而導致排尿的學習行為障礙。研究顯示DV和一些人格氣質及情緒障礙有關，例如外向性行為如過動、暴躁、或攻擊等問題。其發生率和如廁訓練的方式無關。近年來，在成年女性的下尿路疾病，阻塞型症狀的比例較過去的認知為高，而DV可能是膀胱出口阻塞最普遍的原因之一。排尿困難或尿滯留，為其常見的臨床表現。DV的治療，骨盆底肌肉訓練及生理回饋是目前常用的第一線療法。而一些放鬆尿道肌肉的藥物、肉毒桿菌毒素注射、或神經電刺激調節術等也都有人使用，但效果未達證據水準。 文章中也討論了其它非解剖上、非神經性造成女性尿滯留的狀況，如Fowler’s syndrome，PBNO，逼尿肌活性低下，及手術後的尿滯留等。Fowler’s syndrome發生於年輕女性的尿滯留，排尿時尿道括約肌放鬆不良，和多囊性卵巢(polycystic ovary syndrome)有關。手術後尿滯留是臨床常見的問題，統計上和男性、老年、股骨骨折手術、失智、及術中使用藥物等因子相關。 |
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| abstract | Female dysfunctional voiding (FDV) is an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated or levator muscles during voiding in neurologically normal women. Despite its codified definition, because of variable causes, there is a lack of established diagnostic criteria and management. The aim of this study is to give a comprehensive, brief review of the most recent progress in the diagnosis and management of FDV. Currently, there is the need to shed light on several issues in FDV, such as the use of standardized definitions, diagnostic criteria, and treatment modalities. The evaluation of the progress on these matters within 2013 helped to define some key advances in the field of female functional voiding dysfunction and urinary retention. In 2013, many diagnostic and therapeutic questions in female voiding dysfunction remain unsolved. However, some data began to emerge. Patients with FDV did not demonstrate a difference in effortful control (effortful control is the ability to regulate one’s responses to external stimuli), but did demonstrate a higher rate of surgency (surgency is a trait aspect of emotional reactivity in which a person tends towards high levels of positive affect). Toilet training method in childhood does not seem to have any long-term correlation with FDV. Training with pelvic floor physiotherapy and biofeedback still represents the first-line treatment for FDV. In the management of other causes of female voiding dysfunction, sacral neuromodulation demonstrated a satisfying long-term efficacy in the treatment of nonobstructive urinary retention. | |
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