Sarica Kemal, Erbağci Ahmet, Yağci Faruk, Yurtseven Cihanser, Buyukbebeci Orhan, Karakurum Gunhan
Department of Urology, Sahinbey Medical Center, Universisty of Gaziantep Medical School, Turkey.
Scand J Urol Nephrol. 2003;37(4):329-34. doi: 10.1080/00365590310004725.
To present the clinical (urologic, orthopedic and neurologic) and urodynamic findings of 47 children suffering from occult spinal dysraphism, together with the long-term follow-up results obtained with various treatment modalities.
Between 1997 and 2000 a total of 47 children (27 girls, 20 boys; male:female ratio 1.3) referred to the Urology and/or Pediatrics Departments with symptoms and signs of closed spina bifida were enrolled in the study program. All patients underwent routine assessment of the urinary tract, including detailed anamnesis, physical examination and radiologic evaluation (X-ray, renal bladder ultrasonography and sacral MRI). In addition to video-urodynamic evaluation of the lower urinary tract, all patients were also evaluated by the Orthopedic Department with respect to possible lower extremity deformities.
The age range of the children was 2 months to 16 years (mean 6.9 years). At first referral, 23 children were found to have normal urinary and fecal continence after toilet training; among the other presenting symptoms and signs, 34% of patients demonstrated recurrent urinary tract infections and 38.2% had abnormal findings on urinary tract investigations. Evaluation of urodynamic parameters before and after conservative treatment demonstrated an increase in age-related bladder capacity in 34 patients and detrussor instability had been cured in 23/30 patients (p < 0.05). Overall, bladder capacity was found to be normal in 40 children following conservative management (p < 0.05). The conservative approach proved to be effective in 40 children (85.1%), and intravesical instillation therapy with oxybutynine hydrochloride was successful in one of the remaining seven children (14.2%). Bladder augmentation was performed in six children (12.7%) in whom conservative measures were ineffective.
In the light of our findings and the literature data it is obvious that a multidisciplinary approach together with early urologic evaluation to determine the extent of neurologic involvement of the lower urinary tract is essential to ensure a successful treatment outcome and to prevent the occurrence of serious functional and structural complications. Clinical, radiologic and video-urodynamic assessments should be performed to define the neuro-urologic pathophysiology and to provide management guidelines and a baseline for future comparison.
介绍47例隐性脊柱裂患儿的临床（泌尿外科、骨科和神经科）及尿动力学检查结果，以及采用各种治疗方式所获得的长期随访结果。
1997年至2000年间，共有47例因隐性脊柱裂症状和体征转诊至泌尿外科和/或儿科的患儿纳入研究项目。所有患者均接受了泌尿系统的常规评估，包括详细的病史采集、体格检查和影像学评估（X线、肾脏膀胱超声和骶部MRI）。除了对下尿路进行影像尿动力学评估外，所有患者还由骨科评估是否存在可能的下肢畸形。
患儿年龄范围为2个月至16岁（平均6.9岁）。初次转诊时，23例患儿在如厕训练后尿便控制正常；在其他出现的症状和体征中，34%的患者表现为反复尿路感染，38.2%的患者泌尿系统检查有异常发现。保守治疗前后尿动力学参数评估显示，34例患者与年龄相关的膀胱容量增加，30例患者中有23例逼尿肌不稳定得到治愈（p<0.05）。总体而言，40例患儿经保守治疗后膀胱容量正常（p<0.05）。保守治疗对40例患儿（85.1%）有效，其余7例患儿中有1例（14.2%）经盐酸奥昔布宁膀胱内灌注治疗成功。6例患儿（12.7%）保守治疗无效后行膀胱扩大术。
根据我们的研究结果和文献数据，显然多学科方法以及早期泌尿外科评估以确定下尿路神经受累程度对于确保治疗成功和预防严重功能及结构并发症的发生至关重要。应进行临床、影像学和影像尿动力学评估，以明确神经泌尿病理生理学，并提供管理指南和未来比较的基线。
