Urinary frequency, urgency, and lower abdominal discomfort are common urinary dysfunctions that affect the quality of life of a wide range of people worldwide. Although LUTS is not life threatening, patients’ quality of life is severely affected by frequent visits to the toilet, frequent toilet searches, forced to drink less water, long urination times, fear of participating in social activities, inability to work long hours, reduced efficiency, fear of urine leakage and avoidance of sex, etc. The resulting series of psychological disorders such as shame, isolation, depression, etc., directly affect the family and work, and form a vicious circle.
What are the causes of these disorders? The etiology of these diseases is actually very complex, simply speaking, there are obstructive factors, including urethral strictures, urethral orifice polyps, bladder outlet obstruction, and foreign bodies in the bladder. Lesions of the bladder, including post-infectious bladder hypersensitivity, glandular cystitis, interstitial cystitis, and drug-induced ketamine cystitis. Even psychological disorders, tumor compression outside the bladder, etc., may cause these syndromes.
How is it diagnosed? In addition to the “symptoms” that the patient feels, it is very important to keep a urinary diary to assess the time of each urination (what time of day) and the volume of urine (measured with a measuring cylinder) for at least three days, which will help the doctor to identify whether the urination is frequent (more frequent, not more urination) or polyuric (the total volume of urine is really more ). In addition, incontinence, sexual function, bowel status, menstruation, fertility and other conditions should also be mentioned to the doctor. The common tests are mainly urine routine (to clarify whether there is infection and whether there is hematuria). Special urological tests: urinary flow rate, urological ultrasound (including residual urine measurement), mainly to clarify whether there is an obstructive condition. If there are problems with these tests or if the patient is not doing well with medication further tests are needed.
The most important tests include.
1, Urodynamic examination, purpose: to determine the presence or absence of lower urinary tract obstruction and to assess the function of the forced urinary muscle.
2. Cystoscopy: in order to detect diseases such as adenocystitis and mucosal leukoplakia. Of course, if the patient is in a good financial situation, the general situation will first choose non-invasive tests: including urograms, intravenous urography, CT or MRI, but for diseases such as adenocystitis, interstitial cystitis, urethral stricture, bladder neck contracture, these tests are not detected, so these tests are usually applied in order to exclude tumors and stones. Others, such as urinary exfoliated cells and urine culture, then are used only when related diseases are suspected.
Treatment.
(a) Preferred treatment
1. Behavioral training
(1) Bladder training.
Method 1: Delay urination and gradually make each urination volume greater than 300ml.
Method 2: Regular urination
(1) Purpose: To reduce the number of incontinence and improve the quality of life.
②Indications: Those with severe incontinence and difficult to control.
(2)Biofeedback therapy
(3)Pelvic floor muscle training .
(II) Drug therapy
(1) The most used drugs to reduce urinary frequency: tolterodine, solifenacin, etc.
(2) Sedative and anti-anxiety drugs: promethazine, doxorubicin, valium, etc.
(3) Drugs to dilate the urethra: Cordovan, Harlequin, etc.
(C) Optional treatment
1. Multi-point injection of botulinum toxin type A into the bladder forced urinary muscle: it is effective for severe forced urinary muscle instability.
2.Bladder perfusion of RTX, hyaluronidase, capsaicin: the above substances can be involved in bladder sensory afferents, and reduce bladder sensory afferents after perfusion, which can be tried for severe bladder sensory allergy.
3, neuromodulation: sacral nerve electrical modulation therapy, effective for some patients with recalcitrant urinary frequency and urgency and urge incontinence.
(D) Surgery: urethral dilatation, bladder neck incision, bladder mucosal electrocautery, bladder water dilatation, bladder smooth muscle incision, ileal or colonic bladder enlargement, etc. Different surgeries are done according to different conditions.
The above treatment is not set in stone, different patients with different conditions are different treatment options, so do not say that the presence of frequent urination, urinary urgency, lower abdominal discomfort, poor urination, etc., and then randomly inquire about what other people use to treat, for example: if these symptoms are caused by obstructive factors, blindly taking tolterodine or solifenacin is likely to lead to urinary closure and complete inability to urinate. Therefore, it is important for patients to consult a doctor and have tests in place to clarify what kind of symptoms are caused and then choose a treatment according to the situation.