Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum94376ArticlesСтатьиResearch ArticleDiagnosis and treatment of disorders of urination after cerebrovascular accidentsДиагностика и лечение нарушений акта мочеиспускания после острого нарушения мозгового кровообращенияKrivoborodovG. GКривобородовГригорий Георгиевич

д-р мед. наук, проф. каф. урологии НИЛ инновационных технологий в урологии ГБОУ ВПО РНИМУ им. Н.И.Пирогова

dr.krivoborodov@yandex.ruEfremovN. SЕфремовНиколай Сергеевич

канд. мед. наук, ст. науч. сотр. НИЛ инновационных технологий в урологии, ассистент каф. урологии ГБОУ ВПО РНИМУ им. Н.И.Пирогова

TurE. IТурЕлена Ивановна

аспирант каф. урологии ГБОУ ВПО РНИМУ им. Н.И.Пирогова

amadeymozart@yandex.ruN.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian FederationГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова15092015179VOL 17, NO9 (2015)ТОМ 17, №9 (2015)596228122021Copyright ©; 2015, Consilium MedicumCopyright ©; 2015, ООО "Консилиум Медикум"2015Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/94376

It is now well known that acute cerebrovascular accident (CVA) is often accompanied by the development of lower urinary tract symptoms (UT) as a function of the type of violation of emptying the bladder, and the type of storage dysfunction. That is why the question remains timely and correct identification of the type of violation of the lower UT at this category of patients. Today experts have a wide arsenal of methods for the determination of such violations, ranging from voiding diary and questionnaire International Prostate Symptom Score (IPSS) and ending with the execution of complex urodynamic studies. It does not set any clear pattern between the type and location of stroke and the degree of expression or form of violation of the act of urination. Certainly, the presence in patients after stroke, symptoms of lower UT requires selection of adequate and effective method of treatment. In the acute phase of stroke is not uncommon acute urinary retention. In a subsequent independent urination restored in most patients. Unfortunately, at present there is no any effective medication to restore the contractility of the bladder, thus contributing to the elimination of urinary retention. That is why periodic catheterization is the method of choice for an adequate emptying of the bladder in this category of patients individuals with impaired accumulation of urine in the bladder for a broader range of therapeutic measures. Thus, in case of failure of behavioral therapy successfully applied therapy anticholinergics and vnutridetruzornye injection of botulinum toxin type A.

В настоящее время хорошо известно, что острое нарушение мозгового кровообращения (ОНМК) нередко сопровождается развитием симптомов нижних мочевыводящих путей (МП) как по типу нарушения функции опорожнения мочевого пузыря, так и по типу нарушения функции накопления. Именно поэтому актуальным остается вопрос своевременного и правильного определения вида нарушения функции нижних МП у такой категории больных. Сегодня специалисты располагают широким арсеналом методов определения подобных нарушений, начиная от дневника мочеиспусканий и опросника International Prostate Symptom Score (IPSS) и заканчивая выполнением комплексного уродинамического исследования. Не установлено какой-либо четкой закономерности между типом и локализацией ОНМК и степенью выраженности или формой нарушения акта мочеиспускания. Безусловно, наличие у больных, перенесших ОНМК, симптомов нижних МП требует подбора адекватного и эффективного метода терапии. В остром периоде ОНМК нередко встречается острая задержка мочеиспускания. В последующем самостоятельное мочеиспускание восстанавливается у большинства больных. К сожалению, в настоящее время не существует каких-либо эффективных медикаментозных средств, направленных на восстановление сократительной способности мочевого пузыря, что способствовало бы устранению задержки мочеиспускания. Именно поэтому периодическая катетеризация является методом выбора для адекватного опорожнения мочевого пузыря у такой категории пациентов. У лиц с нарушением функции накопления мочи в мочевом пузыре применяют более широкий спектр лечебных мероприятий. Так, в случае неэффективности поведенческой терапии с успехом применяют терапию антихолинергическими препаратами, а также внутридетрузорные инъекции ботулинического токсина типа А.

acute ischemic strokebladderlower urinary tract symptomsincontinenceacute urinary retentionintermittent bladder catheterizationanticholinergic drugsострое нарушение мозгового кровообращениямочевой пузырьсимптомы нижних мочевыводящих путейнедержание мочиострая задержка мочеиспусканияпериодическая катетеризация мочевого пузыряантихолинергические препаратыKalra L, Smith D.H, Crome P. Stroke in patients aged over 75 years: outcome and predictors. Postgrad Med J 1993; 69 (807): 33-6.Arunabh M.V, Baldani G.H. Urologic problems in cerebrovascular accidents. In: D.F.Paulson (ed). Problems in urology. Philadelphia: JB Lipincott, 1993: p. 41-53.Barrett J.A. Bladder and bowel problems after a stroke. Rev Clin Gerontol 2001; 12: 253-67.Wade D.T, Hewer. Outlook after an acute stroke: urinary incontinence and loss of consciousness compared in 532 patients. Q J Med 1985; 56 (221): 601-8.Coletta E.M, Murphy J.B. Physical and functional assessment of the elderly stroke patient. Am Fam Physician 1994; 49: 1777.Blok B, Pannek J, Castro-Diaz D et al. EAU Guidelines on Neuro-Urology. EAU guidelines 2015.Hald T, Bradley W.E. The nervous control of the urinary bladder. In: The Urinary Bladder: Neurology and Urodynamics. Baltimore: Williams & Wilkins, 1982; p. 48.Kong K.H, Young S. Incidence and outcome of poststroke urinary retention: a prospective study. Arch Phys Med Rehabil 2000; 81 (11): 1464-7.Borrie M.J, Campbell A, Caradoc-Davies T.H et al. Urinary incontinence after stroke: a prospective study. Age Ageing 1986; 15: 177.Burney T.L, Senapati M. Desai S et al. Acute cerebrovascular accident and lower urinary tract dysfunction: a prospective correlation of the site of brain injury with urodynamic findings. J Urol 1996; 156: 1748.Khan Z, Starer P, Yang W.C et al. Analysis of voiding disorders in patients with cerebrovascular accidents. Urology 1990; 35: 265.Lum S.K, Marshall V.R. Results of prostatectomy in patients following a cerebrovascular accident. Br J Urol 1982; 54: 186.Jauch E.C, Saver J.L, Jr Adams H.P. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 870-947.Waller L, Johnsson O, Norlen L, Sullivan L. Clean intermittent catheterization in spinal cord injury patients: long term follow - up of a hydrophilic low friction technique. J Urol 1995; 153: 345-8.Abrams P, Cardozo L, Fall M et al. Standardization of Terminology in lower urinary tract function: Report from the standardization sub - committee of International Continence Society. Neurourol Urodyn 2002; 21: 167-78.Brocklehurst J.C, Andrews K, Richards B, Laycock P.J. Incidence and correlates of incontinence in stroke patients. J Am Geriatr Soc 1985; 33: 540-2.Nakayama H, Jorgensen H.S, Pedersen P.M et al. Prevalence and risk factors of incontinence after stroke: the Copenhagen Stroke Study. Stroke 1997; 28: 58-62.Burney T.L, Senapati M, Desai S et al. Effects of cerebrovascular accident on micturition. Urol Clin North Am 1996; 23: 483-90.Brittain K.R, Peet S.M, Potter J.F, Castleden C.M. Prevalence and management of urinary incontinence in stroke survivors. Age & Ageing 1999; 28 (6): 509-11.Taub N.A, Wolfe C.D, Richardson E et al. Predicting the disability of first - time stroke sufferers at 1 year. 12-Month follow - up of a population - based cohort in Southeast England. Stroke 1994; 25: 352.Gelber D.A, Good D.C, Laven L.J, Verhulst S.J. Causes of urinary incontinence after acute hemispheric stroke. Stroke 1993; 24 (3): 378-82.Marinkovic S, Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. J Urol 2001; 165 (2): 359-70.Pizzi A, Falsini C, Martini M et al. Urinary incontinence after ischemic stroke: Clinical and urodynamic studies. Neurourol Urodyn 2014; 33: 420-5.Tsuchida S, Noto H, Yamaguchi O et al. Urodynamic studies on hemiplegic patients after cerebrovascular accident. Urology 1983; 21: 315.Khan Z, Hertanu J, Yang W.C et al. Predictive correlation of urodynamic dysfunction and brain injury after cerebrovascular accident. J Urol 1981; 126: 86.Nitti V.W, Adler H, Combs A.J. The role of urodynamics in the evaluation of voiding dysfunction in men after cerebrovascular accident. J Urol 1996; 155: 263-6.Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturitional disturbance after acute hemispheric stroke: analysis of the lesion site by CT and MRI. J Neurol Sci 1996; 137: 47-56.Badlani G.H, Vohara S, Motola J.A. Detrusor behavior in patients with dominant hemispheric strokes. Neurourol Urodyn 1991; 10: 119.Kuroiwa Y, Tohgi H, Ono S, Itoh M. Frequency and urgency of micturition in hemiplegic patients: relationship to hemisphere laterality of lesions. J Neurol 1987; 234: 100-2.Yokoyama O, Komatsu K, Ishiura Y. Change in bladder contractility associated with bladder overactivity in rats with cerebral infarction. J Urol 1998; 159: 577-80.Brittain K.R, Castleden C.M. Suicide in patients with stroke. Depression may be caused by symptoms affecting lower urinary tract. BMJ 1998; 317 (7164): 1016-7.Williams A. Caregivers of persons with stroke: their physical and emotional well - being. Qual Life Res 1993; 2: 213-20.Patel M, Coshall C, Lawrence E. Recovery from poststroke urinary incontinence: associated factors and impact on outcome. J Am Geriatr Soc 2001; 49: 1229-33.Borrie M. Increased incontinence after stroke. Stroke Rehabilitation. Physical Medicine and Rehabilitation: State of the Art Reviews 1998; 12: 459-72.Eldar R, Ring H, Tshuwa M et al. Quality of care for urinary incontinence in a rehabilitation setting for patients with stroke. Simultaneous monitoring of process and outcome. Int J Qual Health Care 2001; 13 (1): 57-61.Brittain K.R, Perry S.I, Peet S.M et al. Prevalence and impact of urinary symptoms among community - dwelling stroke survivors. Stroke 2000; 31 (4): 886-91.Burgio K.L, Burgio L.D. Behavior therapies for urinary incontinence in the elderly. Clin Geriatr Med 1986; 2 (4): 809-27.Andersson K.E. Antimuscarinics for treatment of overactive bladder. Lancet Neurol 2004; 3: 46-53.Guay D.R. Clinical pharmacokinetics of drugs used to treat urge incontinence. Clin Pharmacokinet 2003; 42 (14): 1243-85.Rovner E.S. Trospium Chloride in the Management of Overactive Bladder Drugs 2004; 64 (21): 2433-46.Wiedemann A, Kusche W, Neumeister C. Flexible Dosing of Trospium Chloride for the Treatment of OAB - Results of a Non - Interventional Study in 4,092 Patients. Open Clin Trials J 2011; 3: 1-5.Bödeker R.H, Madersbacher H, Neumeister C, Zellner M. Dose escalation improves therapeutic outcome: post hoc analysis of data from a 12-week, multicentre, double - blind, parallel - group trial of trospium chloride in patients with urinary urge incontinence. BMC Urol 2010; 10: 15.Schurch B, Stöhrer M, Kramer G. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164 (3 Pt.1): 692-7.Kuo H.C. Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology 200; 63 (5): 868-72.