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林佑樺 帕金森氏症病患合併膀胱過動症狀之尿路動力學機轉評估研究 2019/10/30 下午 06:04:56 0
原 文 題  目 Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease.
作  者 Gregory Vurture, Benoit Peyronnet, Jose-Alberto Palma, Rachael D. Sussman, Dominique R. Malacarne, Andrew Feigin, Ricardo Palmerola, Nirit Rosenblum, Steven Frucht, Horacio Kaufmann, Victor W. Nitti, Benjamin M. Brucker
出  處 Int Neurourol J 2019; 23(3): 211-218.
出版日期 30 September, 2019
評 論 過去針對帕金森氏症的尿路動力學檢查的研究其實相當少,本研究證實了在帕金森氏症有下泌尿道症狀的病患多數伴隨有逼尿肌過動的情況,佔97.1%,然而不管是膀胱出口阻塞(佔36.8%)、逼尿肌收縮功能低下(佔47%)、或是增加解尿後殘尿量(佔16.7%),也佔了很高一定的比例,暗示神經學逼尿肌過動並非唯一的帕金森氏症病人發生下泌尿道症狀的原因,仍然很多時候需要尿路動力學檢查評估並檢視真正發生症狀的疾病問題主因。針對有逼尿肌過動情況的帕金森氏症病人,目前認為發生的主因來自橋腦上的多巴胺傳導路徑失衡,造成排尿神經反射調控異常,進而出現逼尿肌過動的情況。至於逼尿肌過動與逼尿肌收縮功能低下二者是可能並存的,且在帕金森氏症且合併下泌尿道症狀病人中,此類共同表現症狀並不少見。
abstract Purpose

To assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms.

Methods
We performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms.

Results
We included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009).

Conclusions
DO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.

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