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作者：Fran Lowry  
出處：WebMD醫學新聞

　　September 25, 2009 (佛羅里達好萊塢) — 俄亥俄州克里夫蘭大學醫院案例醫學中心Sangeeta T. Mahajan醫師在美國婦女泌尿科協會第30屆年度科學會議中表示，多數的多發性硬化症(MS)病患有中到重度的膀胱過動症(OAB)，但是他們未接受適當的評估或治療，然而，以現有藥物其實可以輕易地處置這個狀況。
　　
　　Mahajan醫師向Medscape Ob/Gyn Women's Health表示，絕對可以提供一些治療給這些病患；膀胱過動可以治療，且我們有多種藥物可供選擇。我們可以用肉毒桿菌治療，也可以用其他藥物治療，但是，不幸的，我們未善盡職責。
　　
　　她表示，MS和泌尿症狀的統計是重要的。有此疾病的400,000名美國人中，75%報告有尿失禁，50%至80%有排尿障礙。MS病患的男女比率為1比2，有十分之一MS病患的第一個症狀就是尿滯留。
　　
　　Mahajan醫師發表的是在2005年秋天對16,585名病患的調查結果，是「North American Research Committee on Multiple Sclerosis (NARCOMS)」這個研究計畫其中的一部份。整體而言，有9,702名MS病患(73,12名女性與2,390名男性；58%)回覆調查。
　　
　　該調查包括有關生活品質與泌尿方面病史、泌尿道評估與治療等問題。有關泌尿道失能的特定問題，包括排尿頻率、急尿頻率、覺得急尿時的漏尿、夜間起床尿尿的頻率等。所有問題的給分為0到3分，根據回覆計算OAB分數。
　　
　　這類病患常見有中到重度OAB症狀。回覆者之中，4,606人(65%)的OAB分數大於等於5分；OAB分數之中位數為5.1。此外，46%有頻尿、43%有急尿、25%有漏尿、48%有夜尿。
　　
　　失能狀況隨著OAB分數增加而增加。MS期間越長，OAB症狀的發生率越高。25%的病患報告使用間歇導尿、10.8%使用Foley導尿管、1.3%使用膀胱導管。
　　
　　該調查顯示，不到半數(47%)病患曾接受過泌尿科評估。中到重度OAB症狀者只有半數(51%)曾經使用抗膽鹼藥物治療。solifenacin、darifenacin與肉毒桿菌等新藥的使用率分別為4.6%、2.9%與 2.1%。
　　
　　Mahajan醫師向Medscape Ob/Gyn Women's Health表示，泌尿科曾經大力推動描述MS病患的泌尿道症狀，但是仍未廣為周知。
　　
　　她表示，神經科醫師會多問問膀胱症狀，但是還可以再加強。被詢問而未接受最新藥物治療的病患，應協助他們就診於泌尿科或婦女泌尿科醫師。
　　
　　該段會議主持人、奧克拉荷馬市奧克拉荷馬大學健康科學中心的Mikio A. Nihira醫師表示，即使使用老藥治療，對這些病患來說都是值得的。
　　
　　Nihira醫師向Medscape Ob/Gyn Women's Health表示，人們曾經批評使用與新藥相比顯得簡單的oxybutynin。但是，我在照護此類病患時觀察發現，對於口乾的耐受程度比沒有MS的病患還要好。我認為這個病況是不幸的，但是我猜，他們得面對更艱難的生活。這些病患通常相當疲累不堪，所以，如果你難以行走，戴護墊或口乾可能比較可以接受。我認為這是個很有趣的研究。
　　
　　另一名主持人、華盛頓大學的Gretchen Lentz醫師指出，因為樣本數夠，此研究特別重要。
　　
　　因為這是調查型研究，我們低估了證據等級，但是即便它只是一個調查，它有大樣本且高達58%的回覆率。重要發現是，這些中到重度尿失禁未被治療。所以，這些病患的照護有很大的改善空間。
　　
　　Mahajan醫師宣告，她是生產Toviaz (fesoterodine fumarate)和Detrol (tolterodine tartrate)之輝瑞藥廠的發言人之一。Nihira醫師和Lentz醫師皆宣告沒有相關財經關係。
　　
　　美國婦女泌尿科協會(AUGS)第30屆年度科學會議。發表於2009年9月24日。

Overactive Bladder Symptoms in Patients With Multiple Sclerosis Go Untreated

By Fran Lowry
Medscape Medical News

September 25, 2009 (Hollywood, Florida) — Most patients with multiple sclerosis (MS) have moderate to severe overactive bladder (OAB) symptoms but they are not receiving appropriate evaluation or treatment, despite the fact that the condition is easily managed with current medications, Sangeeta T. Mahajan, MD, from University Hospitals Case Medical Center in Cleveland, Ohio, reported here at the American Urogynecologic Society 30th Annual Scientific Meeting.

"Something can be done for these patients, absolutely. Overactive bladder is very treatable and we have many medication choices. We can treat them with botox, we can treat them potentially with other medications, but unfortunately we're not really doing a good job," Dr. Mahajan told Medscape Ob/Gyn Women's Health.

The statistics for MS and urinary symptoms are sobering, she said. Of the 400,000 Americans with the disease, 75% report urinary incontinence, and 50% to 80% have voiding dysfunction. One tenth of patients with MS, which affects women twice as often as it does men, present with urinary retention as their first symptom.

Dr. Mahajan presented results from a survey that was sent out to 16,585 patients as part of the North American Research Committee on Multiple Sclerosis (NARCOMS) Project in the fall of 2005. In total, 9702 individuals with MS (7312 females and 2390 males; 58%) responded.

The survey included questions about quality of life and history of urinary and urologic evaluation and treatments. Questions specific to urinary dysfunction asked about frequent urination, urgency, urine leakage related to the feeling of urgency, and getting up at night to pass urine. All questions were scored on a scale of 0 to 3, and an OAB score was calculated from the responses.

Moderate to severe OAB symptoms were common in this population. Of the respondents, 4,606 (65%) had an OAB score of 5 or more; the median OAB score was 5.1. In addition, 46% had urinary frequency, 43% had urgency, 25% had urge leakage, and 48% had nocturia.

As OAB scores increased, so did disability. A longer duration of MS was associated with a higher prevalence of OAB symptoms. Intermittent catheter use was reported by 25% of patients, 10.8% used a Foley catheter, and 1.3% used a suprapubic catheter

The survey showed that less than half (47%) of patients had ever undergone a urologic evaluation. Only half the patients (51%) with moderate to severe OAB had ever been treated with anticholinergic medication. New medications, such as solifenacin, darifenacin, and botox, were used in only 4.6%, 2.9%, and 2.1% of respondents, respectively.

There has been a major push in neurology to address urinary symptoms in MS patients, but the message is still not getting across, Dr. Mahajan told Medscape Ob/Gyn Women's Health.

"Neurologists are asking more frequently about bladder symptoms, but still not as much as they should. And the patients who do get asked are not being treated with the up-to-date medications we give everyone else in the population who go to see a urologist or a urogynecologist," she said.

For Mikio A. Nihira, MD, MPH, from the University of Oklahoma Health Sciences Center in Oklahoma City, who comoderated the session, even treatment with an older medication would be worthwhile in these patients.

Dr. Nihira told Medscape Ob/Gyn Women's Health that "people have criticized the use of simple oxybutynin as opposed to a newer drug. But one thing that I have observed in taking care of these patients is that they tolerate dry mouth much better than patients who do not have MS. I think it's unfortunate, but it's my guess that they deal with such a harder life. These patients are usually so debilitated, so if you have a hard time walking, wearing pads and having dry mouth may be more acceptable. I think it's a very interesting study."

Comoderator Gretchen Lentz, MD, from the University of Washington at Seattle, added that the study was particularly significant because of its size.

"We downplay the level of evidence for a survey type study, but even though it is a survey, it had a large population and a very high response rate of 58%. The significant finding is that these people have moderate to severe incontinence and have not been treated. So there's a lot of room for improvement in the care of these patients."

Dr. Mahajan disclosed that she is a member of the speaker's bureau for Pfizer, which manufactures Toviaz (fesoterodine fumarate) and Detrol (tolterodine tartrate). Dr. Nihira and Dr. Lentz have disclosed no relevant financial relationships.

American Urogynecologic Society (AUGS) 30th Annual Scientific Meeting. Presented September 24, 2009.