Hjälmås K, Passerini-Glazel G, Chiozza M L
Department of Paediatric Surgery, East Hospital, Gothenburg, Sweden.
Scand J Urol Nephrol Suppl. 1992;141:108-14; discussion 115-6.
The basis for the treatment of functional daytime incontinence in children is the bladder regimen, i.e. to teach the children to void regularly by the clock. Drug treatment may be needed as an adjunct to the regimen in children with gross detrusor instability. There is no evidence from properly controlled studies that tricyclic antidepressants or anticholinergic drugs are of value for the child with daytime wetting. Terodiline is a new drug combining anticholinergic and calcium-blocking effects. In two randomized, double-blind studies of terodiline compared with placebo in children with urge incontinence (i.e. functional day wetting), continence improved significantly over placebo in the terodiline group. Only a few mild adverse reactions were noted. Children with symptomatic urinary tract infection and day wetting should receive chemotherapy, but covert bacteriuria should best be left untreated. There is no evidence that eradication of the bacteriuria improves continence. Instead, there is a great risk of symptomatic recurrence of the urinary tract infection after antibacterial treatment.
儿童功能性日间尿失禁的治疗基础是膀胱训练法，即教会儿童按时规律排尿。对于逼尿肌明显不稳定的儿童，可能需要药物治疗作为该训练法的辅助手段。没有来自恰当对照研究的证据表明三环类抗抑郁药或抗胆碱能药物对日间遗尿的儿童有价值。替罗地林是一种兼具抗胆碱能和钙阻滞作用的新药。在两项关于替罗地林与安慰剂对比治疗急迫性尿失禁（即功能性日间遗尿）儿童的随机、双盲研究中，替罗地林组的尿失禁情况相较于安慰剂组有显著改善。仅观察到少数轻微不良反应。有症状性尿路感染和日间遗尿的儿童应接受化疗，但隐匿性菌尿最好不予治疗。没有证据表明根除菌尿能改善尿失禁情况。相反，抗菌治疗后有尿路感染症状复发的巨大风险。
