术后单次与多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果比较

目的比较非肌层浸润性膀胱癌行经尿道膀胱肿瘤电切术（transurethral resection of bladder tumors,TURBT）术后即刻单次与术后1周开始多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果。方法将67例行TURBT术术后的非肌层浸润性膀胱癌患者按随机数字表法分为2组。单次灌注组34例,采用丝裂霉素C 40 mg加入生理盐水40 mL中行TURBT术术后即刻膀胱灌注,共1次。多次灌注组33例,采用丝裂霉素C40 mg加入生理盐水40 mL中在TURBT术术后1周行膀胱灌注,每周1次,共8次。随后每个月1次,共22次。观察2组患者术后3年非肌层浸润性膀胱癌的复发,以及病理学分级为G1、G2＋G3非肌层浸润性膀胱癌的复发等情况。结果单次灌注组、多次灌注组术后3年复发率分别为44.1%、30.3%,2组比较差异无统计学意义（P〉0.05）。单次灌注组、多次灌注组病理学分级为G1复发率分别为18.8%、29.4%,2组比较差异无统计学意义（P〉0.05）;单次灌注组、多次灌注组病理学分级为G2＋G3复发率分别为66.7%、31.3%,2组比较差异有统计学意义（P〈0.05）。结论单次灌注组与多次灌注组预防非肌层浸润性膀胱癌复发的总体效果相当。但对于病理学分级（G2＋G3）较高的非肌层浸润性膀胱癌,多次灌注比单次灌注能更好的减少术后复发。     

逼尿肌A型肉毒毒素重复注射治疗脊髓损伤后逼尿肌反射亢进及神经源性尿失禁

目的评价经尿道膀胱壁逼尿肌A型肉毒毒素重复注射治疗脊髓损伤患者逼尿肌反射亢进和神经源性尿失禁的临床效果。方法损伤平面在骶髓以上的完全性脊髓损伤患者6例,均有单侧或双侧肾积水,严重尿失禁,口服抗胆碱药物治疗效果不理想。将300 U A型肉毒毒素经膀胱镜注射针分30个点注射于除膀胱颈和三角区以外的膀胱壁。重复注射3次。治疗前后行影像尿动力学检查,并记录排尿日记,观察毒副作用。结果重复注射3次平均起效时间10.5 d(5~21 d),3次注射间隔时间分别平均为8.9个月和5.8个月。第1次注射后平均尿失禁次数由10.1/d降至3.3/d,平均导尿量由98.5 ml/次增至404.2 ml/次,平均最大膀胱测压容积由95.4 ml增至385.6 ml,平均充盈末逼尿肌压力由105.8 cmH2O降至31 cmH2O。第2次注射后平均尿失禁次数由9.7/d降至3.7/d,平均导尿量由108.3 ml/次增至387.2 ml/次,平均最大膀胱测压容积由105.4 ml增至375.6 ml,平均充盈末逼尿肌压力由97.8 cmH2O降至33 cmH2O。第3次注射后平均尿失禁次数由9.2/d降至3.9/d,平均导尿量由115.7 ml/次增至363.9 ml/次,平均最大膀胱测压容积由102 ml增至357.6 ml,平均充盈末逼尿肌压力由98.1cmH2O降至36.9cmH2O。随访6个月,未观察到明显毒副作用。结论逼尿肌A型肉毒毒素重复注射是治疗脊髓损伤患者逼尿肌反射亢进和神经源性尿失禁的一种有效、安全的微创方法。     

Botulinum A Toxin/Dimethyl Sulfoxide Bladder Instillations for Women With Refractory Idiopathic Detrusor Overactivity: A Phase 1/2 Study

We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66% dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50% concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52%) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5%; P<.001) and 3 (14%; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.AE = adverse effect; DMSO = dimethyl sulfoxide; IDO = idiopathic detrusor overactivity; IUSS = Indevus Urgency Severity Scale; PVR = postvoid residual; UDI = Urogenital Distress InventoryEstablishment of effective methods for treating overactive bladder symptoms resistant to conventional therapy (eg, anticholinergic medications and neuromodulation) has proven challenging. Encouraging results of intravesical injections of botulinum toxin type A (BOTOX, Allergan, Irving, CA) for patients with neurogenic detrusor overactivity has logically led to interest in botulinum toxin for idiopathic detrusor overactivity (IDO). As a result, multiple investigators have demonstrated the safety and efficacy of intravesical injections of botulinum toxin for IDO since 2003.^1,2 Main drawbacks to intravesical botulinum toxin A are the requirement of cystoscopic injection with individualized anesthetic administration and cost of the agent. We present results of a phase 1/2 prospective study that demonstrated safety and early evidence of clinical efficacy of an intravesical instillation of a botulinum toxin/dimethyl sulfoxide (DMSO) solution to encourage resource allocation for future phase 3 studies.     

Refractory neurogenic detrusor overactivity

Refractory neurogenic detrusor overactivity refers to the clinical condition that is no longer manageable by anticholinergic therapy. This condition represents a formidable task to caregivers because the treatment of urinary incontinence and adequate protection of the upper urinary tract become extremely difficult. Treatment options for refractory neurogenic detrusor overactivity include detrusor injections of botulinum toxin and intravesical instillation of vanilloid compounds, mainly resiniferatoxin, or anticholinergic drugs. If these options fail, bladder augmentation or sacral anterior root stimulation offers excellent outcomes, although at much higher costs and risks to the patients.     

Efficacy of repeat injections of botulinum A toxin to the detrusor in neurogenic bladder overactivity]

PURPOSE: Toxin injections are an effective treatment for neurogenic detrusor overactivity. The efficacy of repeat injections is not well documented. The objective of this study was to evaluate the efficacy of repeat injections of toxin A to the detrusor in patients with neurogenic overactive bladders. MATERIALS AND METHODS: Patients who had received 300-UI injections of Botox(R) were retrospectively studied. The clinical data included continence, duration of the absence of incontinence, changes in anticholinergic dosage or pad use and patient satisfaction. Urodynamic data analyzed were maximal cystometric capacity, bladder contraction and detrusor pressure during contraction. Data were analyzed by Wilcoxon and Kruskal-Wallis tests. RESULTS-DISCUSSION: Data for 42 patients (30 men, 12 women) were analysed. Pathologic features were trauma to the spinal cord, multiple sclerosis or varied causes of myelopathy. Patients received 1 to 6 injections of Botox(R). The mean duration of efficacy was 6 months. Efficacy did not differ among successive injections. Anticholinergic drugs were discontinued in 43% of patients and pad use in 48%. A total of 80% of the patients were satisfied with the treatment. Bladder contraction disappeared in 70% of patients. The mean maximal cystometric capacity increase was 144 ml. CONCLUSION: Clinical and urodynamic data show that repeat injection of toxins to the detrusor remains an effective therapy for neurogenic bladder overactivity. Efficacy for continence is maintained during successive injections.     

骶神经根磁刺激对脊髓损伤后逼尿肌反射亢进的作用

目的：观察骶神经根磁刺激治疗对脊髓损伤所致逼尿肌反射亢进的治疗作用。方法：采用骶神经根磁刺激治疗脊髓损伤后逼尿肌反射亢进的患者,共治疗10天,应用排尿日记、生存质量评分和尿流动力学检查评价疗效。结果：治疗后24h平均排尿次数减少,平均单次排尿量明显增加,平均尿失禁次数相应减少,生存质量提高,治疗有效率达71.4%;尿流动力学结果提示,刺激后最大膀胱测压容积显著增加,充盈末逼尿肌压力明显降低,最大尿流率明显增加。结论：骶神经根磁刺激通过抑制逼尿肌反射,增加膀胱测压容积,增加尿流率,从而改善尿频症状,减少尿失禁,提高生存质量。     

Pharmacotherapy for neurogenic detrusor overactivity

Chancellor MB, Anderson RU, Boone TB: Pharmacotherapy for neurogenic detrusor overactivity. Am J Phys Med Rehabil 2006;85:536-545.Patients with neurogenic detrusor overactivity are a heterogeneous group with voiding dysfunction secondary to neurologic injury or disease. The neurogenic detrusor overactivity syndrome, which may include urinary frequency, urgency, and incontinence, frequently contributes to a loss of independence, or even institutionalization. Urodynamic assessment provides the best method of quantifying and classifying neurogenic detrusor overactivity dysfunction in patients with primary diagnoses as diverse as Parkinson's disease, cerebral palsy, multiple sclerosis, spinal cord injury, and spina bifida. For many patients, management of urinary symptoms includes pharmacotherapy with an anticholinergic agent. Several novel approaches to managing neurogenic detrusor overactivity, including intravesical instillation of anticholinergic agents, vanilloids, and neurotoxins, are being investigated. For most patients, however, flexible dosing with an anticholinergic agent, with clean intermittent catheterization when indicated, has been shown to reduce the risks of urologic complications, improve levels of continence, and enhance patient quality of life in both children and adults.     

丝裂霉素C诱导式卡介苗膀胱灌注预防膀胱肿瘤术后复发的临床研究

【目的】探讨丝裂霉素C（MMC）诱导式卡介苗（BCG）膀胱灌注预防膀胱肿瘤术后复发的疗效及可行性。【方法143例非浸润性尿路上皮癌患者行经尿道膀胱肿瘤电切术（TuRBt）术后分为两组：MMC诱导式BCG组22例（观察组）,术后即刻行MMC膀胱单次灌注,第2周后开始定期行膀胱灌注BCG;单纯BCG组21例（对照组）,TURBt术后第2周开始灌注BCG,并定期进行灌注治疗。两组均定期行膀胱镜检查、尿脱落细胞学检查和随访。【结果]43例术后随访24个月,对照组3例分别于术后2,3,11个月复发,复发率14．3％（3／21）,其余18例未见复发;观察组未见复发病例,两组比较差异有显著性（P〈0．05）。两组均没有严重不良反应和并发症发生。【结论]MMC即刻单次膀胱灌注联合BCG定期膀胱灌注的免疫化学疗法对预防非浸润性膀胱尿路上皮癌术后复发疗效好,不良反应不明显,有较好的临床应用价值。     

经尿道电切术后早期与延期开始膀胱灌注治疗腺性膀胱炎的疗效比较

目的评价经尿道电切术（TUR）术后膀胱灌注治疗开始时间的不同对腺性膀胱炎治疗效果的影响。方法对2007年2月-2012年4月期间的95例有症状腺性膀胱炎患者的临床资料进行回顾性分析,按TUR术后灌注开始的时间不同对患者进行分组,A组37例术后24 h内开始灌注,B组58例术后1周开始灌注。首次灌注后的灌注频率为1次/周,灌注8次后改为1次/月,持续时间5～10个月。随访12～16个月,观察两组的治愈率、好转率、总有效性率、复发率和不良反应发生率。结果两组治愈率、好转率的差异无统计学意义（P〉0.05）,但两组在总有效率、复发率的差异有统计学意义（P〈0.05）;两组不良反应发生率的差异无统计学意义（P〉0.05）。结论腺性膀胱炎TUR术后短时间内（24 h内）即行膀胱灌注治疗可提高疗效,降低复发率,且其不良作用的发生率并不增加。     

髂内动脉灌注化疗联合双联灌注预防膀胱肿瘤电切术后复发

目的了解膀胱肿瘤电切（TURBT）术后行髂内动脉灌注化疗联合双联灌注羟基喜树碱（HCPT）和丝裂霉素C（MMC）在预防膀胱肿瘤复发中的价值,寻找一种理想的减少膀胱肿瘤术后复发的方法。方法本组37例膀胱癌患者,男26例,女11例,年龄45～73岁,平均63岁。随机分为A、B两组。A组（17例）先行TURBT,术后第5天行髂内动脉灌注化疗,一周后开始膀胱灌注,采用HCPT单药灌注。B组（20例）TURBT及髂内动脉灌注化疗同A组,膀胱灌注采用HCPT和MMC双联灌注。结果37例中有32例获得完整随访资料,其中A组15例,B组17例。平均随访时间A组为36.0个月,B组为34.5个月,A组和B组的复发率分别为30%（5/15）和11%（2/17）。结论TURBT术后行髂内动脉灌注化疗联合双联灌注HCPT和MMC能明显减少膀胱肿瘤术后复发。     

A型肉毒毒素膀胱壁注射治疗脊髓损伤患者神经原性膀胱初步观察

目的评估逼尿肌A型肉毒毒素(BAT)注射治疗脊髓损伤患者神经原性膀胱的临床效果。方法78例脊髓损伤患者(男性59例、女性19例)采取BAT(300U溶于15ml生理盐水)经尿道膀胱壁注射(分30个点,0.5ml/点),治疗前后均记录排尿日记,并观察毒副作用。结果78例患者经第1次治疗后,平均尿失禁次数由13.5次/d降至2.7次/d,平均导尿量由131ml/次增至389ml/次,平均尿失禁量由1690ml/d降致281ml/d,起效的平均时间为7.6d;10例患者在第1次注射8.9个月后接受第2次注射,平均尿失禁次数由9.7次/d降至3.7次/d,平均导尿量由108ml/次增至387ml/次;6例患者在第2次注射后5.8个月接受第3次注射,平均尿失禁次数由9.2次/d降至3.9次/d,平均导尿量由116ml/次增至364ml/次。随访期间未观察到任何毒副作用。结论经尿道膀胱壁BAT注射是一种治疗脊髓损伤患者神经原性膀胱的有效、安全、可行、可多次重复应用的微创方法。     

Trospium chloride for the treatment of overactive bladder with urge incontinence

BACKGROUND: Urinary incontinence is caused by an overactive bladder, leading to symptoms of urgency, frequency, and incontinence. Urge incontinence occurs predominantly in women as they age. OBJECTIVES: This article reviews the current primary literature concerning the efficacy and tolerability of the anticholinergic agent trospium chloride (TCl) in the treatment of overactive bladder with symptoms of urge incontinence, urgency, and frequency. The pharmacokinetics of TCl are also reviewed. METHODS: Pertinent articles in English were identified through a search of MEDLINE (1966-present), EMBASE Drugs & Pharmacology (1980-third quarter 2004), Current Contents/Clinical Medicine (week 42, 2003-week 41, 2004), Cochrane Database of Systematic Reviews, MICROMEDEX Healthcare Series, and International Pharmaceutical Abstracts (1970-present). The search terms were overactive bladder, urinary incontinence, trospium, randomized controlled clinical trial, oxybutynin, tolterodine, scopolamine, imipramine, desipramine, and propantheline. RESULTS: TCl, a quaternary amine, exhibits high solubility in water but low oral bioavailability (9.6%) and poor central nervous system penetration. Approximately 80% of the absorbed fraction is renally eliminated as unchanged drug via active tubular secretion, with approximately 15% hepatically metabolized into a spiroalcohol and hydrolysis/oxidation products. In 3 placebo-controlled studies, patients who received TCl had an increase in maximum bladder filling capacity and bladder compliance, with a reduction in maximum cystometric capacity (P < 0.005); however, only 1 of these studies showed an increase in bladder compliance, with reductions in maximum detrusor pressure (P < 0.001), number of voids/d (P < or = 0.001), and incontinence episodes/d (P < or = 0.001). In another placebo-controlled study, TCl reduced the number of voids/d and incontinence episodes/d (both, P < or = 0.001). In 2 double-blind studies, TCl and oxybutynin were similarly effective in significantly increasing maximum cystometric capacity and bladder compliance, and in significantly reducing maximum detrusor pressure compared with baseline (all, P < 0.001); there were no significant differences between the 2 treatments at end point. In a third double-blind study comparing TCl and tolterodine with placebo, only TCl significantly reduced the frequency of micturitions/d (P = 0.01). Commonly reported adverse effects in patients receiving TCl included dry mouth, constipation, and headache. CONCLUSIONS: In the 7 studies reviewed, TCl was effective and well tolerated in patients with urge incontinence caused by idiopathic detrusor muscle overactivity or neurogenic detrusor overactivity resulting from spinal cord injury. However, this agent was associated with anticholinergic adverse effects similar to those of other anticholinergic agents; careful monitoring of tolerability is required.     

经尿道钬激光联合大剂量丝裂霉素灌注治疗腺性膀胱炎

目的 探讨经尿道钬激光联合大剂量丝裂霉素灌注治疗腺性膀胱炎的方法及疗效.方法 经膀胱镜检查及活检确诊58例腺性膀胱炎患者,均行经尿道钬激光切除术,术后给予大剂量丝裂霉素膀胱灌注治疗.结果 58例分别随访6～36个月,37例治愈,16例好转,5例复发.结论 经尿道钬激光切除术后应用大剂量丝裂霉素膀胱灌注能减少腺性膀胱炎术后复发,且副作用少,疗效满意.

Abstract：

Objective To evaluate the method and resultassess the effect of intravesical instillation of high dose mitomycin at high dose combined with transurethral Holmium laser therapy in the treatment of on cystitis glandularis. Methods Fifty-eight patients with cystitis glandularis diagnosed through cystoscope biopsy were treated with intravesical instillation of mitomycin at high dose after transurethral Holmium laser therapy. Results All patients were all followed up in 6 - 36 months. The clinical symptom of Thirty-seven patients disappeared were cured, and 16 patients were alleviated, and 5 patients recurred. Conclusion Combining the transurethral Holmium laser therapy with high dose mitomycin intravesical instillation is effective and safe against local recurrence of cystitis glandularis.     

丝裂霉素C加卡介苗灌注预防浅表性膀胱癌术后复发疗效观察

目的观察丝裂霉素C加卡介苗灌注预防浅表性膀胱癌术后复发的疗效。方法将 83例行经尿道膀胱镜下肿瘤电切术 (TUR)的浅表性膀胱癌患者随机分为丝裂霉素C加卡介苗 (BCG)组 (5 0例 )和单纯丝裂霉素 (MMC)组 (3 3例 ) ,前者术后即刻采用MMC灌注加小剂量BCG维持 ,后者单用传统MMC灌注。观察两组患者的肿瘤复发和毒副反应情况。结果经 12— 66个月 ,平均 3 2个月随访 ,BCG组 3例患者肿瘤复发 ,MMC组 7例患者肿瘤复发 ,两组复发率间的差异有显著性意义 (P <0 .0 5 ) ;BCG组患者毒副反应发生率为 10 % ,MMC组为 66.7%。结论TUR术后即刻膀胱灌注MMC加小剂量BCG维持预防浅表性膀胱癌术后复发疗效较好 ,不良反应少 ,临床使用安全可靠。     

卡介苗加白介素-2膀胱灌注防治浅表性膀胱肿瘤复发的研究

目的寻求膀胱肿瘤复发的有效预防方法。方法52例膀胱肿瘤患者术后分为两组。第1组用丝裂霉素C(MMC)40mg,第2组用卡介苗(BCG)120mg加白介素-2(IL-2)1万U行膀胱灌注。结果随访6~36个月,平均20个月,肿瘤复发率第1组为30.8%(8/26),第2组为7.7%(2/26),两组比较差别有显著性意义(P<0.05)。结论BCG IL-2膀胱内灌注预防浅表性膀胱肿瘤术后复发疗效满意,病人耐受性好,副作用小。     

Bladder instillations with trimethoprim-sulfamethoxazole in the treatment of urinary infection.

205 paraplegic inpatients with urinary infections were treated with trimethoprim-sulfamethoxazole (TMP-SMZ) bladder instillations (160 mg TMP 800 mg SMZ daily for 2 consecutive weeks). 89.3% out of 84 patients with recent vertebral trauma and no history of previous urinary infection (group A), and 68.6% out of 121 patients with paraplegia since more than 2 years, severe chronic infection and various pathological conditions of the urinary tract (group B) were found to be sterile at the end of the trial. The intravesical concentrations of 3.2 mg/ml TMP and 16 mg/ml SMZ which are reached immediately after instillation are 50--100 times superior to the minimal growth-inhibitory concentrations for most sensitive germs as determined with agar dilution tests. Several strains of Klebsiella and Proteus which had previously proved resistant to oral treatment were eliminated with intravesical TMP-SMZ. The incidence of reinfection, evaluated 1 month after interruption of treatment, was particularly high (62.7%) in patients with known involvement of the upper tract of intravesical obstruction with postmicturition residuals above 75 ml. On the other hand, 28% only among the patients with recent spinal injury and integrity of the upper urinary tract became reinfected after the same interval. The absence of local intolerance could be confirmed in all 21 cystoscopically examined patients between the 6th and 11th day of treatment. Hematuria was never encountered. Systemic side effects were noted in 7.8% Serum concentrations of both drug components are being investigated; results will be published elsewhere.     

Bladder wall thickness on ultrasonographic cystourethrography: affecting factors and their implications.

OBJECTIVE: To explore factors affecting bladder wall thickness on ultrasonographic cystourethrography in female patients with lower urinary tract symptoms. METHODS: The records of 492 female patients with lower urinary tract symptoms who had undergone a urodynamic study and ultrasonography of the lower urinary tract and who had normal urinalysis findings, negative urine culture results, or both were identified from our urogynecologic database. These included 248 patients with urodynamic stress incontinence, 38 with detrusor overactivity, 39 with mixed incontinence, 35 with a hypersensitive bladder, 42 with voiding difficulty, and 90 with normal urodynamic findings. RESULTS: Age, resting bladder neck angle, urethral mobility, and maximum urethral closure pressure were significantly associated with bladder wall thickness at the trigone and dome. Bladder wall thickness at the trigone was correlated with that at the dome (P < .0001). Bladder wall thickness at the trigone was positively correlated with pressure transmission ratios in the first and second quarters of the urethra (P < .0001; P = .002, respectively), whereas that at the dome was positively correlated with intravesical pressure at maximum flow and with detrusor opening pressure (P = .027; P = .046, respectively). Age and intravesical pressure at maximum flow were independently associated with bladder wall thickness at the trigone and dome (P = .007; P = .028), respectively. A thickened bladder wall was a common finding in female lower urinary tract symptoms, except in the patients with a hypersensitive bladder. CONCLUSIONS: Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both.     

艾迪注射液膀胱灌注预防非肌层浸润性膀胱尿路上皮癌术后复发的临床观察

目的探讨用中药制剂——艾迪注射液膀胱灌注预防非肌层浸润性膀胱尿路上皮癌术后复发的临床效果及不良反应。方法 95例非肌层浸润性膀胱尿路上皮癌保留膀胱手术后随机分为3组,分别采用丝裂霉素（MMC）、沙培林、艾迪注射液进行膀胱灌注,定期随访,观察治疗效果及毒副反应。结果 95例患者随访14～57个月（平均37.1个月）,共有30例出现肿瘤复发（Ta9例,T121例;G114例,G29例,G37例）,肿瘤复发率为31.6%。MMC组、沙培林组和艾迪注射液组的肿瘤复发率分别为48.5%、28.1%和16.7%。MMC组及艾迪注射液组与沙培林组的肿瘤复发率差异无统计学意义（P〉0.05）;艾迪注射液组肿瘤复发率明显低于MMC组（P〈0.05）。MMC组、沙培林组和艾迪注射液组出现明显不良反应者分别为7例（21.2%）、3例（9.4%）和0例。结论中药制剂——艾迪注射液膀胱灌注预防非肌层浸润性膀胱尿路上皮癌术后复发疗效较好,无明显不良反应,临床使用安全、可靠。     

电针中极和关元治疗脑卒中后急迫性尿失禁的效果

目的 观察电针中极和关元治疗脑卒中后急迫性尿失禁的临床效果。 方法 2015年5月至2018年5月,40例脑卒中后急迫性尿失禁患者随机分为对照组(n = 20)和电针组(n = 20),两组均行常规治疗,电针组另予电针中极和关元,共4周。治疗前后完成72小时排尿日志,采用尿失禁程度量表进行评分,并行尿流动力学检查。 结果 对照组17例、电针组18例完成试验。两组治疗后总排尿次数、急迫性尿失禁次数和夜间因排尿护理者被叫起次数显著减少,平均尿量显著增加,尿失禁程度量表评分显著下降(|t| > 4.770, P < 0.001);电针组均明显优于对照组(| t| > 2.962, P < 0.01)。两组治疗后,最大膀胱测量容量和膀胱顺应性显著增加,最大膀胱压力和最大逼尿肌压力显著降低(| t| > 4.052, P < 0.001),电针组优于对照组(| t| > 2.716, P < 0.05)。 结论 电针中极和关元可显著改善急迫性尿失禁症状,与减小逼尿肌压力和膀胱压力、增大膀胱容量、改善膀胱顺应性有关。