神经源性膀胱诊断、分型和治疗研究进展

Advances in diagnosis,typing and treatment of neurogenic bladder

神经源性膀胱(neurogenic bladder,NB)是一种由神经损害或病变所致的下尿路功能障碍,可引发多种下尿路症状,同时合并多系统并发症,严重者可导致肾衰竭。神经源性膀胱的病因复杂,主要包括神经系统因素、感染性疾病和医源性因素。由于病因复杂,临床表现缺乏特异性,神经源性膀胱的诊断、分型和治疗是临床亟需解决的重点及难点问题。本文系统性地归纳了神经源性膀胱的诊断标准,包括病史采集、排尿日记、实验室检查、泌尿系超声、尿动力学检查和神经电生理;汇总了神经源性膀胱的疾病分型法,如国际尿控协会(INTERNATIONAL CONTINENCE SOCIETY,ICS)分型法、廖氏分型法、Madersbacher分型法、Krane-Siroky分型法和SALE分型法等;整理了临床现有的神经源性膀胱的治疗方法,如药物治疗、手术治疗和骶神经电刺激术;结合了国内外组织工程和干细胞研究的最新进展,展望神经源性膀胱治疗的新方向。

Neurogenic bladder(NB)is a lower urinary tract dysfunction caused by injury or lesion of the nervous system,which can cause a variety of lower urinary tract symptoms,combined with multiple system complications,and in severe cases can lead to kidney failure.The etiology of neurogenic bladder is complex,mainly including nervous system factors,infectious diseases,and iatrogenic factors.Due to the complex etiology and lack of specific clinical manifestations,the diagnosis,classification and treatment of neurogenic bladder are the key and difficulties that need to be solved in clinical practice.This article systematically summarized the diagnostic criteria for neurogenic bladder,including history taking and voiding diaries,laboratory tests,urinary system ultrasound,urodynamic studies,and neurophysiological assessments.It also compiled the existing disease classification systems for neurogenic bladder,such as the ICS classification,Liao classification,as well as the Madersbacher,Krane-Siroky,and SALE classification systems.Furthermore,it organized the current treatment methods available for neurogenic bladder,including pharmacological therapies,surgical interventions,and sacral nerve stimulation.Finally,the article discussed the latest advancements in tissue engineering and stem cell research,exploring new directions for the treatment of neurogenic bladder.