多发性硬化症患者的泌尿系统症状常被忽略

奥兰多——根据多发性硬化症中心联盟与美国多发性硬化症(MS)治疗与研究委员会第15次合作会议上报告的一项全国性MS患者调查结果，MS患者下泌尿道症状很常见，也很令人苦恼，但常常得不到探讨和治疗。

这份在线调查涉及1,052例通过全国多发性硬化症协会及其他患者倡导组织募集的MS患者。总共有88%的回应者表示存在下泌尿道症状，其中包括膀胱功能不良及尿失禁。MS患者产生这些常见症状的根源在于膀胱逼尿肌收缩活性增加。

回应者报告的最常见下泌尿道症状是终末尿滴沥，65%的患者有这一症状；其次是尿急，发生率为62%；尿不尽发生率为61%。53%的患者报告有急迫性尿失禁，45%主诉存在压力性尿失禁。患者认为最令人烦恼的下泌尿道症状是尿急，共有1/3的回应者表示自己受到这个问题的困扰“相当多”或“非常多”；29%的回应者表示受到急迫性尿失禁困扰“相当多”。

在922例有下泌尿道症状的MS患者中，仅1/3在过去1年中曾经与医护人员探讨过这些症状，在与专业人士交谈时，有74%是与其神经科医生交谈；52%在过去1年中曾向其初级保健医生提出这一问题。在表示受到尿失禁的困扰至少“相当多”的回应者(占42%)中，有46%在过去1年中未曾与医护人员探讨过这个问题，35%从未因此接受任何形式的治疗。在从未与医生或其他医务人员探讨过其下泌尿道症状的患者中，38%报告目前通过盆腔肌肉训练或膀胱功能训练治疗这个问题，23%在使用1种口服抗胆碱能药物，4%在服用中药进行对症治疗，3%在接受A型肉毒杆菌毒素注射，2%拥有1台神经刺激设备。目前正在治疗下泌尿道症状的患者多数声称对治疗非常或较为满意。

这项调查由爱力根公司资助，报告者为加州爱力根公司的Kristin M. Khalaf博士。

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By: BRUCE JANCIN, Internal Medicine News Digital Network

ORLANDO – Lower urinary tract symptoms in patients with multiple sclerosis are common, bothersome, and often undiscussed and untreated, according to a national patient survey.

The online survey was completed by a convenience sample of 1,052 MS patients recruited through the National Multiple Sclerosis Society and other patient advocacy organizations. Fully 88% of the respondents indicated they have lower urinary tract symptoms involving bladder dysfunction and urinary incontinence. The source of these common symptoms in patients with MS is increased contractile activity of the bladder’s detrusor muscle.

The most common lower urinary tract symptom reported by survey respondents was terminal dribble upon voiding, which affected 65% of patients. The next most common symptoms were urinary urgency, experienced by 62%, and incomplete emptying, cited by 61%, Kristin M. Khalaf, Pharm.D., reported at the fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Fifty-three percent of patients reported having urgency urinary incontinence, and 45% complained of stress urinary incontinence.

The lower urinary tract symptom that patients found most bothersome was urgency; indeed, one-third of the overall study population indicated they were bothered "quite a bit" or "a great deal" by this problem. Twenty-nine percent of respondents stated they were bothered at least quite a bit by urgency incontinence, added Dr. Khalaf of Allergan, Irvine, Calif.

Only one-third of the 922 MS patients with lower urinary tract symptoms had discussed their symptoms with a health care provider during the past year. When they did speak with a professional, 74% of the time it was with their neurologist. Fifty-two percent spoke to their primary care physician about their problem within the last year.

Among the 42% of survey respondents who indicated they were bothered at least quite a bit by urinary incontinence, 46% hadn’t discussed the problem with a health care provider within the past year, and 35% had never received any form of treatment for it.

Among patients who had ever discussed their lower urinary tract symptoms with a physician or other health care professional, 38% reported currently treating their problem via pelvic exercises or bladder training, 23% were using an oral anticholinergic agent, 4% were taking herbal medicines for their symptoms, 3% were receiving botulinum toxin type A (onabotulinumtoxinA) injections, and 2% had a neural stimulation device.

Most patients currently receiving treatment for their lower urinary tract symptoms pronounced themselves very or somewhat satisfied with their therapy.

The survey was funded by Allergan.