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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 大容量膀胱的原因 | 2008/3/28 上午 09:58:15 | 0 |
| 原 文 | 題 目 | The pathophysiology of large capacity bladder. |
| 作 者 | Purohit RS, Blaivas JG, Saleem KL, Sandhu J, Weiss JP, Reddy B, Sidhu RK. | |
| 出 處 | Journal of Urology | |
| 出版日期 | 2008 Mar;179(3):1006-11. | |
| 評 論 |
在這個充滿焦慮，OAB的時代，如果病患擁有一個「大膀胱」，似乎可以解決經常去上廁所的困擾，但是大膀胱是就健康的膀胱嗎？ 來自紐約州康乃爾大學Dr. Blaivas的研究團隊回溯性調查2900位錄影尿路動態學的檢查結果中，找到100個膀胱容量大於700ml的病患，分析結果顯示48%有膀胱出口阻塞，11%是閉尿肌無力，24%是閉尿肌無收縮，很有趣的是17%正常膀胱，4%是膀胱過動，8%有低順應性膀胱，糖尿病佔5%。 平均cystometric膀胱容量是1090ml，平均餘尿585ml，功能性膀胱容量(functional bladder capacity)369ml，由此看來容量雖大，但有效排空能力和正常人差不多。 心臟科有個Frank-Starling law代表心舒張期有更多的血流入心室，在心收縮期也會有更多血液打出去，這理論當然也適用於膀胱，只是如果膀胱容量超出彈性範圍則會發生彈性無力。 在這通貨膨脹資源匱乏的2008年，任何東西都要求「大」「多」，「成長」的價值觀要負部分責任，擁有太少往往造成人們焦慮和不安，不過讀了這篇文章告許我們適當的擁有才是健康之道。 |
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| abstract |
PURPOSE: We describe the pathophysiology, differential diagnosis and urodynamic findings in patients with a large capacity bladder. MATERIALS AND METHODS: This was a retrospective, observational study of 100 consecutive patients with voiding dysfunction and a cystometric bladder capacity of greater than 700 ml. Clinical data, cystometric bladder capacity and other urodynamic findings were evaluated. Bladder outlet obstruction and impaired detrusor contractility were defined by the Schaefer nomogram in men and the Blaivas-Groutz nomogram in women. RESULTS: A total of 56 men and 44 women 36 to 97 years old (median age 75, mean 71.2) with a bladder capacity of 700 to 5,013 ml (median 931, mean 1,091) were studied. The primary pathophysiological diagnoses were bladder outlet obstruction in 48% of cases, impaired detrusor contractility in 11%, absent detrusor contractility in 24% and normal detrusor pressure/uroflow study in 17%. Bladder outlet obstruction was attributable to anatomical obstruction in 34% of patients, acquired voiding dysfunction in 11% and detrusor-external sphincter dyssynergia in 3%. In patients with detrusor contractions the initial contraction occurred at a median of 1,000 ml (mean 1,154, range 86 to 5,000). Associated diagnoses in men included benign prostatic enlargement in 52% and neurological disease in 14%, and in women they were pelvic organ prolapse in 27%, stress incontinence in 18% and neurological disorders in 9%. CONCLUSIONS: The etiology of large capacity bladder is multifactorial and often a potentially remediable underlying condition exists. A large capacity bladder may be accompanied by bladder outlet obstruction, impaired or absent detrusor contractions, or normal detrusor pressure/uroflow studies. When detrusor contractions are present, they usually occur only at large bladder volumes. Therefore, it is important during cystometry to fill the bladder until capacity is achieved. |
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