Schwöbel M, Bodmer C
Chirurgischen Klinik, Universitäts-Kinderspitals Zürich, Schweiz.
Wien Med Wochenschr. 1998;148(22):508-10.
Voiding disorders in children are frequent. To establish an exact anamnesis, it has to be distinguished between enuresis and incontinence and this may consequently already have a therapeutical effect. Enuresis is defined as a normal void occurring at an inappropriate time or place. Incontinence is an involuntary loss of urine and a pathological voiding habit, often in combination with urinary infections. The causes of an enuresis are always functional, the causes for incontinence may be organic or functional. Organic causes are neurogenic bladder dysfunctions or structural anomalies of the lower urinary tract. The functional causes are divided in urge incontinence, dysfunctional voiding, lazy bladder syndrome and stress incontinence. The most important screening examination in each child with voiding disorders is the uroflowmetry, in combination with an electromyography (EMG) of pelvic floor and abdominal muscles. For registration of the muscle activity, surface electrodes are used that only show muscle groups, but do not hurt on application. Cystometry, an invasive method, is used as a second step. The therapy of functional incontinence consists in bladder training, physiotherapy of the pelvic floor and biofeedback. Medicaments are given in second priority. The therapy of functional voiding disorders is only successful in cooperation with the child and its parents.
儿童排尿障碍很常见。为了准确了解病史，必须区分遗尿和尿失禁，而这可能因此已经产生治疗效果。遗尿被定义为在不适当的时间或地点出现的正常排尿。尿失禁是尿液的不自主流失以及一种病理性排尿习惯，常与泌尿系统感染并发。遗尿的原因总是功能性的，尿失禁的原因可能是器质性的或功能性的。器质性原因是神经源性膀胱功能障碍或下尿路结构异常。功能性原因分为急迫性尿失禁、排尿功能障碍、膀胱惰性综合征和压力性尿失禁。对每个有排尿障碍的儿童进行的最重要的筛查检查是尿流率测定，并结合盆底和腹部肌肉的肌电图（EMG）。为记录肌肉活动，使用表面电极，其仅显示肌肉群，且应用时不会造成伤害。膀胱测压作为一种侵入性方法，用于第二步检查。功能性尿失禁的治疗包括膀胱训练、盆底物理治疗和生物反馈。药物治疗为次要手段。功能性排尿障碍的治疗只有在与儿童及其父母合作的情况下才会成功。
