Kev Pom Zoo Ntawm Kev Kho Mob Urological hauv Parkinson's Disease Patients Part 1

Cov ntsiab lus

Parkinson's disease (PD) tau lees paub tias yog cov kab mob neurodegenerative tshaj plaws tom qab Alzheimer's disease. Cov tsos mob ntawm cov urinary qis yog tshwm sim nyob rau hauv cov neeg mob uas muaj PD, xws li cov tsos mob cia (cov tsos mob ntawm lub zais zis ntau dhau los yog OAB) los yog cov tsos mob tsis muaj zog.

Parkinson's disease yog ib hom kab mob hauv lub paj hlwb uas nws cov tsos mob tseem ceeb muaj xws li txhav, tshee, thiab tsis sib koom tes. Ntxiv nrog rau cov kev tawm dag zog no, Parkinson tus kab mob feem ntau cuam tshuam nrog cov tsos mob xws li kev nco tsis zoo. Tab sis tib neeg yuav tsum tsis txhob txhawj xeeb txog kev sib txuas ntawm kev nco tsis zoo thiab tus kab mob Parkinson. Ntau cov kev tshawb fawb tau pom tias qhov tshwm sim ntawm kev nco tsis nco qab hauv cov neeg mob Parkinson tus kab mob tsis siab, thiab cov teeb meem cuam tshuam feem ntau tshwm sim tsuas yog thaum tus kab mob loj hlob mus rau theem hnyav dua.

Txawm hais tias kev nco tsis zoo tuaj yeem cuam tshuam nrog Parkinson tus kab mob, muaj ntau yam uas koj tuaj yeem ua los tawm tsam cov teeb meem no. Piv txwv li, los ntawm kev tswj hwm txoj kev noj qab haus huv thiab ua haujlwm hauv txhua hnub, tib neeg tuaj yeem ua kom nco tau zoo txawm tias muaj tus kab mob Parkinson. Qhov tseem ceeb tshaj, teeb tsa lub sijhawm ua tau, faib sijhawm kom tsim nyog, tsom mus rau lub zog, thiab tsim kom muaj kev pw tsaug zog zoo tuaj yeem pab tib neeg txhim kho lawv txoj kev nco thiab tswj kev noj qab haus huv.

Txhawm rau txhim kho kev nco, cov neeg mob Parkinson tuaj yeem koom nrog qee qhov kev cob qhia thiab kev ua ub no, xws li koom nrog kev paub txog kev coj cwj pwm, kev nyeem ntawv, kawm txuj ci tshiab, thiab ua cov teeb meem kev txawj ntse yooj yim. Cov dej num no pab txhawb tib neeg lub hlwb, thiab txhim kho kev mloog thiab kev xav, thaum txhim kho kev nco thiab kev xav, pab tib neeg kom daws tau cov kab mob zoo dua thiab muaj lub neej zoo dua.

Hauv cov ntsiab lus, txawm hais tias Parkinson tus kab mob tuaj yeem cuam tshuam nrog cov teeb meem nco, nws tsis yog ib qho teeb meem loj heev. Los ntawm kev siv lub neej noj qab nyob zoo, koom nrog hauv kev ua ub no txhua hnub, thiab koom nrog qee qhov kev cob qhia thiab kev ua ub no, tib neeg tuaj yeem tiv thaiv cov teeb meem no zoo dua, txhim kho lawv txoj kev nco thiab kev xav, thiab txaus siab rau lub neej zoo. Nws tuaj yeem pom tias peb yuav tsum txhim kho kev nco, thiab Cistanche deserticola tuaj yeem txhim kho kev nco zoo vim Cistanche deserticola yog cov khoom siv tshuaj hauv Suav teb uas muaj ntau yam teebmeem, ib qho ntawm kev txhim kho kev nco. Kev ua tau zoo ntawm Cistanche deserticola los ntawm ntau yam khoom xyaw uas nws muaj, suav nrog tannic acid, polysaccharides, flavonoid glycosides, thiab lwm yam. Cov khoom xyaw no tuaj yeem txhawb lub hlwb kev noj qab haus huv los ntawm ntau txoj hauv kev.

Nyem paub 10 txoj hauv kev los txhim kho kev nco

Cov kev kuaj mob tseem ceeb tshaj plaws rau kev cuam tshuam ntawm cov zis yog muab los ntawm tus neeg mob cov keeb kwm kho mob. Kev ntsuam xyuas Urodynamic tso cai rau kev txiav txim siab ntawm lub zais zis hauv qab thiab tuaj yeem pab xaiv kev kho mob.

Pharmacologic interventions tshwj xeeb tshaj yog cov tshuaj anticholinergic yog thawj kab kev xaiv rau kev kho OAB rau cov neeg mob PD. Txawm li cas los xij, nws yog ib qho tseem ceeb kom sib npaug cov txiaj ntsig kev kho mob ntawm cov tshuaj no nrog rau lawv cov txiaj ntsig tsis zoo. Intra-detrusor Botulinum toxin txhaj thiab hluav taws xob stimulation kuj tau siv los kho OAB hauv cov neeg mob uas muaj peev xwm sib txawv.

Mirabegron yog B3-agonist uas tuaj yeem siv rau OAB nrog kev ua siab ntev rau cov tshuaj anticholinergics. Desmopressin muaj txiaj ntsig zoo rau kev tswj hwm ntawm nocturnal polyuria uas tau tshaj tawm tias muaj ntau hauv PD.

Kev phais lub hlwb sib sib zog nqus (DBS) ua haujlwm zoo hauv kev txhim kho. kev ua haujlwm urinary hauv cov neeg mob PD. Kev sib deev tsis zoo kuj tseem muaj nyob rau hauv PD, Phosphodiesterase type 5 inhibitors yog thawj kab kev kho mob rau PD-koom nrog erectile kawg (ED). Kev kho mob nrog apomorphine sublingually yog lwm txoj kev kho mob rau cov neeg mob PD nrog ED. Pathological hypersexuality muaj qee zaus tau tshaj tawm hauv cov neeg mob PD, txuas nrog dopaminergic agonists.

Thawj kauj ruam ntawm kev kho mob ntawm hypersexuality yog txo cov tshuaj dopaminergic. Qhov kev tshuaj xyuas no qhia txog cov kab mob sib kis, kab mob, kab mob, kev pheej hmoo, caj ces, kev kuaj mob tshwm sim, kev kuaj mob, thiab kev tswj xyuas qhov kawg, cov txiaj ntsig urological thiab kev kho mob raug tshuaj xyuas.

KEYWORDS: Tus kab mob Parkinson; Kev ua haujlwm tsis zoo ntawm cov zis; Neurogenic zais zis, Urology.

Taw qhia

Parkinson's disease (PD) yog ib qho mob neurodegenerative zog tshaj plaws. Hauv Tebchaws Europe, qhov ntau thiab qhov tshwm sim ntawm PD yog kwv yees li ntawm 108-257/100 000 thiab 11-19/100 000 ib xyoos, raws li (1).

Txawm hais tias qhov ua rau PD tsis paub, qhov tshwm sim pathologic cuam tshuam nrog kev poob lossis kev ua haujlwm tsis zoo ntawm dopaminergic neurons hauv substantia nigra pars compacta (2).Neuropathologic hallmark ntawm PD yog lub xub ntiag ntawm Lewy lub cev muaj feem ntau ntawm alpha-synuclein andubiquitin.

Nws ntseeg tau tias qhov tshwm sim ntawm PD yog vim muaj kev sib txuas ntawm caj ces thiab ib puag ncig (3). Cov tsos mob ntawm lub cev ntawm PD yog tremor, rigidity, bradykinesia / akinesia, thiab postural instability, tab sis cov duab kho mob muaj xws li lwm yam lub cev muaj zog thiab cov tsos mob uas tsis yog motors. (4).

Ntau yam tsos mob uas tsis yog lub cev muaj zog muaj ntau hauv PD. Lawv suav nrog kev cuam tshuam kev ua haujlwm tsis zoo nrog orthostatic hypotension, cem quav, urinary disturbances, ntau yam kev pw tsaug zog tsis zoo, thiab cov tsos mob ntawm neuropsychiatric (5).

Kev kuaj mob ntawm PD yog nyob ntawm keeb kwm thiab kev kuaj mob. Keeb kwm tuaj yeem suav nrog cov yam ntxwv prodromal (qhov muag nrawm nrawm, kev pw tsaug zog tsis zoo, hyposmia, cem quav), cov yam ntxwv ntawm kev txav tsis yooj yim (tremor, txhav, qeeb), thiab teeb meem kev puas siab puas ntsws (kev paub tsis meej, kev nyuaj siab, kev ntxhov siab). Kev kuaj mob feem ntau qhia tau tias bradykinesia nrog tshee, nruj, lossis ob qho tib si.

Dopamine transporter ib leeg-photon emissions suav tomography tuaj yeem txhim kho qhov tseeb ntawm kev kuaj mob thaum muaj Parkinsonism tsis meej (6). Kev kuaj mob tsis raug ntawm Parkinson'stremor thiab qhov tseem ceeb tremor yog ib qho tshwm sim.Electrophysiological thiab functional imaging tests can be useful in the distinction of the two, but two approaches suffers from some limits (7).

PD cuam tshuam nrog ntau yam ntawm lub neej zoo, tshwj xeeb tshaj yog muaj feem xyuam rau kev ua haujlwm ntawm lub cev thiab kev sib raug zoo (8).Lub hom phiaj tseem ceeb hauv kev tswj hwm ntawm PD yog kho cov tsos mob ntawm lub cev muaj zog thiab cov yam ntxwv tsis zoo ntawm qhov tsis sib xws.

Kev tswj kom zoo yuav tsum muaj kev sib xyaw ua ke ntawm cov tswv yim tsis yog tshuaj thiab tshuaj tshuaj kom ua kom tau txais txiaj ntsig zoo tshaj plaws (9). Qhov ncauj levodopa, qhov pib kub-txheej txheem kev kho rau PD, tseem yog qhov zoo tshaj plaws thiab siv ntau txoj kev kho mob (10).

Nyob rau hauv advancedPD, cov kev kho mob muaj xws li cov cuab yeej pab kho mob xws li kev nruam subcutaneous apomorphine infusion, levodopa-carbidopa plab hnyuv gel infusion, thiab sib sib zog nqus hlwb stimulation (11). Kev txhawb nqa uas tsis yog-pharmaco cov txheej txheem kho mob tau siv rau hauv cov neeg mob thaum ntxov thiab qib siab.

Nws yuav tsum suav nrog kev kho lub cev, txhawb kev puas siab puas ntsws, kev kho mob ua haujlwm, kev hais lus, lus, thiab kev kho nqos, thiab khoom noj khoom haus (12). Lub zais zis ua haujlwm tsis zoo hauv PD. Tej zaum lawv yuav tshwm sim nyob rau txhua theem ntawm tus kab mob thiab ua rau mob zuj zus ntxiv thiab ua rau muaj kab mob hnyav dua. Qhov tseem ceeb tshaj plaws kev ua haujlwm yog qhov hu ua overactive zais zis (OAB).

Cov teeb meem tseem ceeb ntawm kev kho mob ntawm cov neeg mob PD muaj qhov txo qis nrog qhov ua rau ua rau muaj zog ntawm cov leeg detrusor, lub ntsiab lus xav kom tso zis thaum tsis muaj lub zais zis txaus (13). Feem ntau cov tsos mob ntawm cov neeg mob nrog PD yog nocturia, ua raws li zaus thiab tso zis. Qee cov neeg mob tau nthuav tawm cov tsos mob ua haujlwm tsis zoo.

Feem ntau cov tsos mob obstructive yog ua tsis tiav ntawm lub zais zis (14). Obstructive cov tsos mob yuav besecondary rau anticholinergics, obstructive uropathy, los yog taw tes rau muaj ntau yam kab mob atrophy (MSA).

Kev ua haujlwm tsis zoo ntawm striated urethral sphincter thiab pelvicmusculature tuaj yeem pom nyob rau hauv cov lej sib txawv hauv PD (15). Cov tshuaj Antimuscarinic yog thawj kab kev kho mob rau OAB cov tsos mob. Cov tshuaj Antimuscarinic tuaj yeem ua rau cem quav thiab xerostomia ntau dua, thiab kev ceeb toom tau ceeb toom thaum siv cov tshuaj no hauv cov neeg uas xav tias muaj kev puas siab puas ntsws. 

Desmopressin muaj txiaj ntsig zoo rau kev tswj hwm ntawm nocturnal polyuria uas tau tshaj tawm tias muaj ntau hauv PD. Intra-detrusorinjections ntawm botulinum toxin yog kev kho mob zoo fordetrusor overactivity, txawm li cas los xij, cuam tshuam nrog kev pheej hmoo ntawm kev tso zis (16).

Subthalamic sib sib zog nqus hlwb stimulation (DBS) muaj ib tug tseem ceeb thiab urodynamically recordableeffect ua rau ib tug normalization ntawm pathologicallyincreased zais zis rhiab heev (17). Percutaneous tibial nervestimulation (PTNS) txhim kho cov tsos mob ntawm cov zis andurodynamic tsis nyob rau hauv cov neeg mob PD (18).

Kev sib deev dysfunction (SD) hauv PD, tau raug pom zoo los ntawm lub hauv paus thiab kev ua haujlwm tsis zoo ntawm lub cev ua haujlwm los ntawm kev ua haujlwm tsis zoo, txo kev ntseeg tus kheej, thiab kev puas siab puas ntsws xws li kev ntxhov siab thiab kev nyuaj siab (19).

Feem ntau ntawm SD tau tshaj tawm siab rau cov neeg mob txiv neej (65%), tab sis qis dua hauv cov poj niam cov neeg mob (36%).Muaj ntau hom SD: erectile kawg (ED) thiab tsis muaj ejaculation tswj hauv cov txiv neej cov neeg mob, thiab kev hwm tus kheej ntau dua. hauv cov poj niam cov neeg mob (20).

Optimaldopaminergic kev kho mob yuav tsum pab txhawb kev sib deev ntsib ntawm ob niam txiv. Kev tawm tswv yim tsim nyog yuav txo qis qee qhov teeb meem (tsis kam koom nrog kev sib deev, teeb meem nrog ejaculation, lubrication, thiab tso zis incontinence).

Kev kho mob ntawm ED nrog sildenafil thiab apomorphine yog pov thawj raws (21). Peb tau ua cov lus piav qhia piav qhia txog kev sib kis, kab mob, kab mob, kev pheej hmoo, kev pab cuam caj ces, kev kho mob, kev kuaj mob, thiab kev kho mob ntawm PD.

Tus kws kho mob urologist muaj lub luag haujlwm tseem ceeb hauv kev tswj hwm ntawm urological manifestations ntawm cov neeg mob nrog PD. Peb tau tshuaj xyuas cov ntaub ntawv tam sim no hais txog cov txiaj ntsig urological thiab kev tswj xyuas cov neeg mob PD.

KHOOM PLIG THIAB MUAB

Peb tau tshawb nrhiav cov ntaub ntawv hluav taws xob suav nrog PubMed, theScopus database rau kev tshawb fawb luam tawm uas txheeb xyuas lub luag haujlwm ntawm Cov Ntsiab Lus Kho Mob hauv qab no: 'Parkinson's disease' (AND) 'Kev Tswj Xyuas' (AND) 'Diagnosis'(AND) 'kev kis mob' (AND) ' genetic contribution' (AND) 'risk factor' (OR) 'Parkinson's disease' (AND) 'urlogic dysfunction' (AND) 'Management' (OR) 'Parkinson's disease'(AND) 'Erectile dysfunction' (AND) 'Kev tswj hwm' .

Qhov no tau ua tiav los xyuas kom meej cov ntsiab lus suav nrog cov kab mob neurogenic zais zis hauv cov neeg mob PD. Kev tshawb nrhiav thawj zaug tau ua rau 350 kab lus. Tom qab tshuaj xyuas, peb pib tshem tawm cov ntaub ntawv uas tsis cuam tshuam (72).

Tom qab kev tshuaj xyuas, cov khoom raug xaiv raws li lawv qhov chaw kho mob ntsig txog lub hom phiaj. Thaum tag nrho cov duplicates raug muab pov tseg, tag nrho ntawm 90 daim ntawv tau siv los rho tawm cov ntaub ntawv tsim nyog.

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