Bàng quang quá hoạt ở bệnh nhân nam: Dịch tễ học, nguyên nhân, đánh giá và điều trị

Current Bladder Dysfunction Reports - Tập 1 - Trang 52-60 - 2006
William I. Jaffe1, Alexis E. Te
1Broad and Ontario Streets, Temple University School of Medicine, Philadelphia, USA

Tóm tắt

Cách tiếp cận của các bác sĩ tiết niệu đối với chẩn đoán và điều trị triệu chứng đường tiểu dưới (LUTS) ở bệnh nhân nam đã thay đổi đáng kể trong thập kỷ qua. Những tiến bộ trong lĩnh vực khoa học cơ bản kết hợp với một lượng lớn dữ liệu lâm sàng đã chỉ ra tầm quan trọng của bệnh sinh bàng quang trong sự phát triển của các triệu chứng tiểu tiện. Trong quá khứ, những người đàn ông có LUTS thường được chẩn đoán với thuật ngữ “prostatism,” một thuật ngữ bao hàm chứa cả triệu chứng tiểu tiện và triệu chứng lưu trữ có thể hoặc không liên quan đến sự tắc nghẽn tuyến tiền liệt. Song song với những tiến bộ khoa học trong lĩnh vực này, từ vựng tiết niệu đã bắt đầu phát triển và cho phép chúng ta mô tả một cách cụ thể hơn, và do đó điều tra và điều trị, các khía cạnh khác nhau của LUTS ở nam giới. Hiện nay, đã được công nhận rộng rãi rằng nhiều người đàn ông gặp phải triệu chứng lưu trữ có thể liên quan nhiều hơn đến rối loạn bàng quang hơn là sự tắc nghẽn tuyến tiền liệt. Việc tích hợp hiểu biết của chúng ta về sự phát triển và tắc nghẽn tuyến tiền liệu, phản ứng của bàng quang đối với sự tắc nghẽn đầu ra, và các yếu tố môi trường và lối sống, cũng như các thay đổi liên quan đến tuổi tác sẽ rất quan trọng để hiểu đầy đủ về bệnh sinh phức tạp của LUTS ở nam giới, đặc biệt là hội chứng bàng quang quá hoạt.

Từ khóa

#bàng quang quá hoạt #triệu chứng đường tiểu dưới #bệnh sinh bàng quang #rối loạn chức năng bàng quang #chẩn đoán điều trị LUTS

Tài liệu tham khảo

Abrams P, Cardozo L, Fall M, et al.: The standardization of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002, 21:167–178. Wein AJ, Rovner ES: Definition and epidemiology of overactive bladder. Urology 2002, 60 (suppl 5A):7–12. Hampel C, Weinhold D, Benker N, et al.: Definition of overactive bladder and epidemiology of urinary incontinence. Urology 1997, 50(suppl 6):4–14. Milsom I, Stewart W, Thuroff J: The prevalence of overactive bladder. Am J Managed Care 2000, 6(suppl):S565-S573. Stewart WF, Van Rooyen JB, Cundiff GW, et al.: Prevalence and burden of overactive bladder in the United States. World J Urol 2003, 20:327–336. Temml C, Heidler S, Ponholzer A, Madersbacher S: Prevalence of the overactive bladder syndrome by applying the International Continence Society definition. Eur Urol 2005, in press. Milsom I, Abrams P, Cardozo L, et al.: How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001, 87:760–766. Tubaro A: Defining overactive bladder: epidemiology and burden of disease. Urology 2004, 64(suppl 6A):2–6. Stothers L, Thom D, Calhoun E: Urologic diseases in America project. Urinary incontinence in males: demographics and economic burden. J Urol 2005, 173:1302–1308. Hu T, Wagner TH, Bentkover JD, et al.: Estimated economic costs of overactive bladder in the United States. Urology 2003, 61:1123–1128. Barry MJ, Cockett ATK, Holtgrewe HL, et al.: Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J Urol 1993, 132:474–479. de la Rosette JJ, Witjes WP, Schaefer W, et al.: Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-“BPH” study. Neurourol Urodyn 1998, 17:99–108. Roberts RO, Jacobsen SJ, Jacobson DJ, et al.: Longitudinal changes in peak urinary flow rates in a community-based cohort. J Urol 2000, 163:107–113. Sarma AV, Jacobsen SJ, Girman CJ, et al.: Concomitant longitudinal changes in frequency of and bother from lower urinary tract symptoms in community dwelling men. J Urol 2002, 168:1446–1452. Rhodes T, Girman CJ, Jacobsen SJ, et al.: Longitudinal growth rates during 5 years in randomly selected community men 40 to 79 years old. J Urol 1999, 16:1174–1179. Andersen JT, Nordling J, Walter S: Prostatism. I: The correlation between symptoms, cystometric and urodynamic findings. Scand J Urol Nephrol 1979, 13:229–236. Hyman MJ, Groutz A, Blaivas JG: Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol 2001, 166:550–553. Gades NM, Jacobson DJ, Girman CJ, et al.: Prevalence of conditions potentially associated with lower urinary tract symptoms in men. BJU Int 2005, 95:549–553. Kumar V, Cross RL, Chess-Williams R, Chapple CR: Recent advances in basic science for overactive bladder. Curr Opin Urol 2005, 15:222–226. Charlton RG, Morley AR, Chambers P, et al.: Focal changes in nerve, muscle, and connective tissue in normal and unstable human bladder. BJU Int 1999, 84:953–960. O’Reilly BA, Kosaka AH, Chang TK, et al.: A quantitative analysis of purinoceptor expression in the bladders of patients with symptomatic outlet obstruction. BJU Int 2001, 87:617–622. Levin RM, Haugaard N, O’Connor L, et al.: Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: a direct comparison. Neurourol Urodyn 2000, 19:609–629. Levin RM, Brading AF, Mills IW, Longhust PA: Experimental models of bladder obstruction. In Prostatic Diseases. Edited by Lepor H. Philadelphia: W. B. Saunders; 2000:169–196. Levin RM, Naugaard N, O’Connor L, et al.: Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: a direct comparison. Neurourol Urodyn 2000, 19:609–629. O’Reilly BA, Kosaka AH, Chang TK, et al.: A quantitative analysis of purinoceptor expression in the bladders of patients with symptomatic outlet obstruction. BJU Int 2001, 87:617–622. Smith DJ, Chapple CR: In vitro response of human bladder smooth muscle in unstable obstructed male bladders: a study of pathophysiological causes? Neurourol Urodyn 1994, 13:414–415. Kim JC, Kim DB, Seo SI, et al.: Nerve growth factor and vanilloid receptor expression, and detrusor instability, after relieving bladder outlet obstruction in rats. BJU Int 2004, 94:915–918. Schroder A, Newgreen D, Andersson KE: Detrusor responses to prostaglandin E2 and bladder outlet obstruction in wild-type and Ep1-receptor knockout mice. J Urol 2004, 172:1166–1170. Khan MA, Thompson CS, Angelini GD, et al.: Prostaglandins and cyclic nucleotides in the urinary bladder of a rabbit model of partial bladder outlet obstruction. Prostaglandins Leukot Essent Fatty Acids 1999, 61:307–314. Schroder A, Tajimi M, Matsumoto H, et al.: Protective effect of an oral endothelin-converting enzyme inhibitor on rat detrusor function after outlet obstruction. J Urol 2004, 172:1171–1174. Kaplan SA, Bowers DL, Te AE, Olsson CA: Differential diagnosis of prostatism: a 12-year retrospective analysis of symptoms, urodynamics, and satisfaction with therapy. J Urol 1996, 155:1305–1308. Van Venrooij GE, Van Melick HH, Eckhardt MD, et al.: Correlations of urodynamic changes with changes in symptoms and well-being after transurethral resection of the prostate. J Urol 2002, 169:605–609. Nordling J: The aging bladder: a significant but under-estimated role in the development of lower urinary tract symptoms. Exp Gerontol 2002, 37:991–999. Elbadawi A, Yalla SV, Resnick NM: Structural basis of geriatric voiding dysfunction. III: detrusor overactivity. J Urol 1993, 150:1668–1680. Elbadawi A, Yalla SV, Resnick NM: Structural basis of geriatric voiding dysfunction. IV: bladder outlet obstruction. J Urol 1993, 150:1681–1695. Bayliss M, Wu C, Newgreen D, et al.: A quantitative study of atropine-resistant contractile responses in human detrusor smooth muscle, from stable, unstable and obstructed bladders. J Urol 1999, 162:1833–1839. AUA Practice Guidelines Committee: AUA guideline on management of benign prostatic hyperplasia. Chapter 1: diagnosis and treatment recommendations. J Urol 2003, 170:530–547. Machino R, Kakizaki H, Ameda K, et al.: Detrusor instability with equivocal obstruction: a predictor of unfavorable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodyn 2002, 21:444–449. Reynard JM, Yang Q, Donovan JL, et al.: The ICS-BPH Study: uroflowmetry, lower urinary tract symptoms, and bladder outlet obstruction. Br J Urol 1998, 82:619–623. Porru D, Jallous H, Cavalli, et al.: Prognostic value of a combination of IPSS, flow rate, and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002, 41:246–249. Kolman C, Girman CJ, Jacobsen SJ, et al.: Distribution of postvoid residual urine in randomly selected men. J Urol 1999, 161:122–127. McNeill SA, Hargreave TB, Geffriaud-Ricouard C, et al.: Postvoid residual urine in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a pooled analysis of eleven controlled studies with alfuzosin. Urology 2001, 57:459–465. Nitti VW, Lefkowitz G, Ficazzola M, Dixon CM: Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J Urol 2002, 168:135–138. Nitti VW, Kim Y, Combs AJ: Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings. J Urol 1997, 157:600–603. Wadie BS, El-Husseiny EE, Gomha MA: The relationship of detrusor instability and symptoms with objective parameters used for diagnosing bladder outlet obstruction: a prospective study. J Urol 2002, 168:132–134. Gonzalez RR, Te AE: Overactive bladder and men: indications for anticholinergics. Curr Urol Rep 2003, 4:429–435. Gormley E, Griffiths D, McCracken P, et al.: Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males. Neurourol Urodyn 1993, 12:445–453. Leng WW, Davies BJ, Tarin T, et al.: Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol 2004, 172:1370–1381. de Nunzio C, Franco G, Rocchegiani A, et al.: The evolution of detrusor overactivity after watchful waiting, medical therapy, and surgery in patients with bladder outlet obstruction. J Urol 2003, 169:535–539. Abrams P, Kaplan S, Millard R: Tolterodine treatment is safe in men with bladder outlet obstruction and symptomatic detrusor overactivity. Proceedings of the International Continence Society 32nd Annual Meeting. Seoul, Korea: September 18–20, 2001. Athanasopoulos A, Gyftopoulos K, Giannitsas K, et al.: Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003, 169:2253–2256. Gerber G, Kim J, Contreras B, et al.: An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin. Urology 1996, 47:840–844. Schwinn DA, Price DT, Perinchery N: Alpha-1 adrenoreceptor subtype selectivity and lower urinary tract symptoms. Mayo Clin Proc 2004, 79:1423–1434. Herbison P, Hay-Smith J, Ellis G, et al.: Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. BMJ 2003, 326:841–844. Resnick NM, Yalla SV: Detrusor hyperactivity with impaired contractile function: an unrecognized but common cause of incontinence in elderly patients. JAMA 1987, 257:3076–3081. Siegel SW, Catanzaro F, Dijkema HE, et al.: Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology 2000, 56:87–91.