Overview
Overactive bladder (OAB)It is a syndrome characterized by urgency symptoms, often accompanied by frequent urination and nocturia symptoms, with or without urge incontinence, which significantly affects patients' daily life and social activities, has become a major disease . In recent years, with the entry of China into an aging society, as well as the growth of diabetes and neurological damaging diseases, the incidence of bladder-related overactive diseases, which is secondary to this, has increased year by year.
"Guidelines for the diagnosis and treatment of overactive bladder" pointed out that OAB is a syndrome characterized by urgency symptoms, often accompanied by frequent urination and nocturia symptoms, with or without urge incontinence; urodynamics It manifests as detrusor overactivity and can also be other forms of urinary tract and bladder dysfunction. Does not include symptoms caused by acute urinary tract infections or other forms of local lesions of the bladder and urethra.
Cause
The cause is still unclear. It is currently believed that the following four factors may be relevant:
Detrusor instability
Due to non-neurogenic factors, abnormal contraction of the detrusor during storage of the urine causes corresponding clinical symptoms.
2. Bladder hypersensitivity
Urination occurs when the bladder capacity is small.
3. The urinary tract and pelvic floor muscles are abnormal.
4. Other reasons
Such as abnormal mental behavior, hormonal metabolism disorders.
Clinical manifestation
Typical symptoms include urgency, frequent urination, nocturia, and urge incontinence.
Urgency
It refers to a sudden, intense desire to urinate, and it is difficult to be subjectively inhibited and delay urination.
2. Urge incontinence
It refers to urinary incontinence that occurs immediately after urgency or immediately after urgency.
3. Frequent frequency
For a complaint, the patient consciously urinated too often every day. On the basis of subjective feelings, the number of adult urination reaches: no less than 8 times during the day, no less than 2 times during the night, and urinary frequency is considered when the urine volume is less than 200ml.
4. Nocturia
Refers to the patient's complaint of urinating due to urinary sensation twice a night.
an examination
Screening test
The general inspection items that patients should complete include:
(1) Medical history OAB is a symptomatic diagnosis, so the inquiry of medical history is very important. It should cover the typical symptoms of the disease, related symptoms and related medical history, and should be evaluated by urination diary.
(2) Physical examination includes male genitourinary system, female reproductive system and nervous system examination to understand whether there is a primary factor causing OAB. For elderly men with OAB symptoms, rectal examination should be performed to understand whether there is prostate. Related diseases, etc.
(3) Laboratory examination 0AB diagnosis should first exclude infectious factors, so routine urine examination is essential.
(4) special examination of urology such as urine flow rate, measurement of residual urine and transrectal prostate color ultrasonography, etc., to understand the functional status of the lower urinary tract.
2. Selective inspection
Refers to selective examination of patients suspected of having a certain urinary or reproductive system, including urological or reproductive system pathogens, urine cytology, etc., if necessary, depending on the situation, KUB, IVU or MRI.
diagnosis
The diagnosis of overactive skin disease (OAB) is based on clinical symptoms as the main diagnosis. Because the pathogenesis of OAB is not clear, it involves many factors such as bladder sensory nerve, urinary center, motor nerve, detrusor and other forms, and other forms of storage and urinary dysfunction can also cause non-inhibitory contraction of the detrusor. Therefore, the correct diagnosis of OAB depends on screening and selective testing.
treatment
Behavioral therapy
(1) Bladder training The efficacy of bladder training in the treatment of OAB is positive. Through bladder training, bladder contraction is inhibited and bladder capacity is increased. Training points are to drink plenty of water during the day, try to endure the urine, prolong the interval between urination; no longer drink water after the night, do not drink irritating, excitable drinks, at night, take appropriate sedative sleeping pills to sleep quietly. Record the urination diary during treatment to enhance the confidence of the cure.
(2) Biofeedback treatment People consciously urinate and control urination due to the existence of certain biological information in the body. Biofeedback therapy is the application of a biofeedback therapy device that amplifies these in vivo information for use by patients, learns to incorporate these unattended information into the control of consciousness, and actively urinates or controls urination. The feedback therapy device placed in the anus or vagina records the activity of the bladder in the form of sound, light, image, etc. When the patient has uninhibited contraction or unstable contraction of the detrusor, the instrument emits specific sound, light, and image. Such information enables the patient to directly sense bladder activity and consciously learn to self-control gradually, to achieve the purpose of inhibiting bladder contraction.
(3) Pelvic floor muscle training Through biofeedback or other guidance methods, patients can learn to inhibit bladder contraction and other strategies to suppress urgency by contracting the pelvic floor muscles.
(4) Other behavioral treatments such as hypnotherapy.
2. Drug treatment
(1) M receptor antagonists Drug therapy is easily accepted by most OAB patients and is therefore the most important and basic treatment for OAB. Detrusor contraction is mediated by agonistic cholinergic (M receptor), which inhibits detrusor contraction by antagonizing M receptors, improves bladder sensory function, and inhibits detrusor instability. Therefore, it is widely used in the treatment of OAB. First-line drugsTolterodine, trasamine, solifena, etc., other drugs haveOxibutin, propoflavin, profenesin and the like.
(2) Sedation, anti-anxiety drugs Multiple areas of the central nervous system are involved in urination control, such as cortex and diencephalon, as well as the midbrain, medulla and spinal cord. Neurotransmitters associated with these neural pathways, such as gamma-aminobutyric acid, can be selected,Serotonin, dopamine and glutamic acid. Among the therapeutic drugs for OAB, imipramine is the most commonly used. It not only has anticholinergic and sympathomimetic effects, but also centrally inhibits urinary reflex. It is recommended for the treatment of mixed urgency and stress urinary incontinence. However, imipramine has a slower onset of action and can only be effective after several weeks of use. Adverse reactions were orthostatic hypotension and arrhythmia. Another antidepressant, duloxetine, increases the extra-urethral sphincter tone by inhibiting the central reuptake of serotonin and norepinephrine.
(3) Calcium channel blockers experiments have shown that calcium antagonists such as verapamil and nifedipine can inhibit bladder detrusor contraction by blocking extracellular calcium influx; potassium channel openers pass Increase the outflow of potassium ions, causing hyperpolarization of the cell membrane and relaxation of smooth muscle.
(4) Other drugs Prostaglandin synthesis inhibitors (Indomethacin), flavone piperidine and the like.
3. Chinese medicine treatment
In recent years, Chinese medicine has been tried for the treatment and adjuvant treatment of OAB. Its curative effect is exact, the adverse reactions are small, and it is increasingly accepted by doctors and accepted by patients. Including traditional Chinese medicine therapy, acupuncture therapy, massage therapy, bladder irrigation therapy, rectal medication, external treatment, incense therapy.
4. Surgical treatment
Surgical treatment is only used for severely low compliance bladder, bladder volume is too small, and the upper urinary tract function is impaired, and other treatments are ineffective. Including detrusor transection, autologous bladder enlargement, intestinal bladder enlargement, urinary diversion.
5. Other treatments
Including multi-point injection of type A botulinum toxin bladder detrusor, which is effective for severe detrusor instability. It can also infuse hyaluronidase or capsaicin in the bladder. These substances can participate in bladder sensory afferent, reduce bladder sensory afferent after perfusion, and can be tried for severe bladder hypersensitivity. Neuromodulation, sacral nerve electrical conditioning treatment is effective in some patients with recurrent urinary frequency, urgency and urge incontinence.
In conclusion, OAB patients often use a combination of behavioral therapy and drug therapy. M receptor antagonists are the main means of treating OAB today, and their efficiency can reach 75%.
简体中文