Feldman Adam S, Bauer Stuart B
Massachusetts General Hospital, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2006 Apr;18(2):139-47. doi: 10.1097/01.mop.0000193289.64151.49.
This review will focus on the diagnosis and management of voiding dysfunction in neurologically and anatomically normal children. The discussion will highlight recent developments and research in the clinical approach as well as the etiology and classification of these disorders.
Voiding dysfunction in children encompasses a wide spectrum of clinical entities, recently classified collectively as dysfunctional elimination syndromes. Voiding dysfunction typically presents after toilet training and may originate from behavioral issues that arise around this time in childhood development. The spectrum of disorders includes urge syndrome, dysfunctional voiding with an uncoordination between the detrusor and urinary sphincter, and enuresis. Clinical symptoms may vary from mild incontinence to severe disorders with endpoints of irreversible bladder dysfunction with vesicoureteral reflux, urinary tract infection and resulting nephropathy. Diagnosis relies heavily on a good history and physical examination, but also includes radiologic and urodynamic evaluation. Treatment generally consists of medical therapy, primarily with anticholinergics as well as behavioral therapy to modify learned voiding patterns that contribute to the voiding dysfunction.
This overview of voiding dysfunction in children outlines the established approaches to its diagnosis and treatment and highlights the most recent developments in the field.
本综述将聚焦于神经和解剖结构正常儿童的排尿功能障碍的诊断与管理。讨论将着重于临床方法的最新进展和研究，以及这些病症的病因和分类。
儿童排尿功能障碍涵盖了广泛的临床病症，最近被统称为功能性排尿障碍综合征。排尿功能障碍通常在如厕训练后出现，可能源于儿童发育这个阶段出现的行为问题。病症范围包括尿急综合征、逼尿肌与尿道括约肌不协调的功能性排尿障碍以及遗尿症。临床症状可能从轻度尿失禁到严重病症不等，严重时会导致膀胱功能不可逆、膀胱输尿管反流、尿路感染及肾病。诊断很大程度上依赖于详细的病史和体格检查，但也包括影像学和尿动力学评估。治疗通常包括药物治疗，主要是使用抗胆碱能药物，以及行为治疗，以改变导致排尿功能障碍习得性排尿模式。
本儿童排尿功能障碍综述概述了其诊断和治疗的既定方法，并突出了该领域的最新进展。
