【AUA指南更新】膀胱过度活动症（OAB）
译者述评
春字书法鉴于中美两国医疗体制的差异，对于AUA的OAB指南应该结合我国具体情况学习应用。
对于OAB的诊断首先是一个排除性诊断，只有在排除了原位癌、结核、感染、结石等器质性病变的基础上才能诊断原发性OAB，仅仅根据尿急、尿频等OAB症状就给予药物治疗往往会掩盖或漏诊导致产生OAB症状的原始病因，同时由于原发病因未解决，单纯的药物治疗也往往没有好的效果，在避免过度检查和充分精确评估之间寻找平衡需要一定的临床经验。
部分药物如抗毒蕈碱药物的国内剂型，尚无儿童用药的获得药监局官方批准的指证，临床应用时应做到充分知情同意。部分微创治疗方式如A型肉毒毒素（100U）逼尿肌注射仅限于临床试验，在我国暂待获得药监局批准，实施前应经过伦理备案并做到充分的知情同意以避免不必要的医疗纠纷。
Guideline Statements
指南荟萃
Diagnosis 诊断
1. The clinician should engage in a diagnostic process to document symptoms and signs that characterize OAB and exclude other disorders that could be the cau of the patient’s symptoms; the minimum requirements for this process are a careful history, physical exam, and urinalysis. Clinical Principle
1. 临床医师应参与诊断过程，记录OAB的症状和体征，排除可能导致患者OAB症状的其他疾病；必须进行仔细的询问病史、体检和尿液分析。（临床原则）
2. In some patients, additional procedures and measures may be necessary to validate an OAB diagnosis, exclude other disorders and fully inform the treatment plan. At the clinician’s discretion, a urine culture and/or post-void residual asssment may be performed and information from bladder diaries and/or symptom questionnaires may be obtained. Clinical Principle一切都是过去式
2. 部分患者可能需要进一步的检查和评估来确证OAB的诊断，排除其他疾病，并充分告知
患者治疗计划。根据临床医生的判断，可以进行尿培养和/或残余尿评估，并可以从膀胱日记和/或症状问卷中获得信息。（临床原则）
3. Urodynamics, cystoscopy and diagnostic renal and bladder ultrasound should not be ud in the initial workup of the uncomplicated patient. Clinical Principle
3. 对于初筛单纯性OAB患者，初次检查时不推荐进行尿动力学检查、膀胱镜检查和诊断性肾膀胱超声检查。（临床原则）
4. OAB is not a dia; it is a symptom complex that generally is not a lifethreatening condition. After asssment has been performed to exclude conditions requiring treatment and counling, no treatment is an acceptable choice made by some patients and caregivers. Expert Opinion
4. OAB不是一种疾病；它是一种通常情况下不会危及生命的综合症。在评估后排除了需要进一步治疗和观察的情况下，部分患者和老年衰弱者可以不接受特殊治疗。（专家意见）礼仪的定义
5. Clinicians should provide education to patients regarding normal lower urinary tract fun袋鼠尾巴的作用
ction, what is known about OAB, the benefits versus risks/burdens of the available treatment alternatives and the fact that acceptable symptom control may require trials of multiple therapeutic options before it is achieved. Clinical Principle
航线
5. 临床医师应当向患者进行关于下尿路正常功能、什么是OAB等知识的健康宣教，可选择治疗方案的益处与风险/负担比例，以及达到临床可接受的症状控制前可能需要尝试多种治疗方案的告知。（临床原则）
Treatment 治疗
➤ First-Line Treatments: Behavioral Therapies
➤ 一线治疗：行为治疗
6. Clinicians should offer behavioral therapies (e.g., bladder training, bladder control strategies, pelvic floor muscle training, fluid management) as first linetherapy to all patients with OAB. Standard (Evidence Strength Grade B)
6. 所有OAB患者，临床医师应将行为治疗（如膀胱训练、膀胱控制策略、盆底肌肉训练、液体管理）作为一线疗法。标准（证据强度等级B）
7. Behavioral therapies may be combined with pharmacologic management. Recommendation (Evidence Strength Grade C)
7. 行为疗法可以与药物治疗相结合。推荐（证据强度等级C）
➤ Second-Line Treatments: Pharmacologic Management
➤ 二线治疗：药物治疗
被授权人
8. Clinicians should offer oral anti-muscarinics or oral β3-adrenoceptor agonists as cond-line therapy. Standard (Evidence Strength Grade B)
8. 临床医生应将口服抗毒蕈碱药物或口服β3-肾上腺素受体激动剂作为第二线治疗。标准（证据强度等级B）
中国民俗大全9. If an immediate relea (IR) and an extended relea (ER) formulation are available, t
hen ER formulations should preferentially be prescribed over IR formulations becau of lower rates of dry mouth. Standard (Evidence Strength Grade B)
9. 如果同时有速释型制剂（IR）和缓释型（ER）制剂可供选择，那么由于较低的口干发生率，应当优先选择缓释型（ER）制剂。标准（证据强度等级B）
10. Transdermal (TDS) oxybutynin (patch or gel) may be offered. Recommendation (Evidence Strength Grade C)
10.透皮剂型（TDS）的奥昔布宁制剂（贴片或凝胶）可以选择使用。推荐（证据强度C级）
11. If a patient experiences inadequate symptom control and/or unacceptable adver drug events with one antimuscarinic medication, then a do modification or a different anti-muscarinic medication or a β3-adrenoceptor agonist may be tried. Clinical Principle
11. 如果应用一种抗毒蕈碱药物后患者症状控制不满意和/或不能耐受的药物不良反应，那么可以尝试调整药物剂量，或者更换为其他种类的抗毒蕈碱药物、以及更换为β3-肾上腺素
受体激动剂。（临床原则）
12. Clinicians may consider combination therapy with an anti-muscarinic and β3-adrenoceptor agonist for patients refractory to monotherapy with either anti-muscarinics or β3-adrenoceptor agonists. Option (Evidence Strength Grade B)
12. 对于单一使用抗毒蕈碱药物或β3-肾上腺素受体激动剂治疗无效的患者，临床医生可以考虑联合使用抗毒蕈碱药物和β3-肾上腺素受体激动剂治疗。可选（证据强度等级B）
13. Clinicians should not u anti-muscarinics in patients with narrow-angle glaucoma unless approved by the treating ophthalmologist and should u anti-muscarinics with extreme caution in patients with impaired gastric emptying or a history of urinary retention. Clinical Principle
13. 除非经眼科医师批准，否则临床医生不应在患有窄角型青光眼的患者中使用抗毒蕈碱类药物，对有胃排空障碍或有尿潴留病史的患者使用抗毒蕈碱类药物应极其慎重。（临床原则）
14. Clinicians should manage constipation and dry mouth before abandoning effective anti-muscarinic therapy. Management may include bowel management, fluid management, do modification or alternative antimuscarinics. Clinical Principle
