Department of Neurosurgery and Urology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
Urology. 2010 Jan;75(1):161-5. doi: 10.1016/j.urology.2009.06.100. Epub 2009 Oct 24.
To identify the factors that might predict which individuals ultimately fail to resolve voiding symptoms by analyzing their presenting symptoms and video-urodynamic findings. Older children with intractable voiding dysfunction and no evidence of neurologic abnormality, who are recalcitrant to medical treatment, pose a management challenge.
The charts of neurologically normal children with intractable voiding dysfunction, who had fluorourodynamic studies and normal lumbosacral magnetic resonance imaging, were reviewed. A database was created that included the urodynamics, presenting urinary symptoms, presence of soiling or constipation, age at onset of symptoms, cystogram and bladder ultrasound findings, and treatments given. Long-term follow-up was determined from chart review (all patients) or by a mailed survey (15 patients). Patients without symptoms and off medication were defined as normal.
A total of 50 children met the criteria mentioned earlier in the text, presented at a mean age of 9.4 years (range, 3.8-17.3) and were followed up for a mean of 4 years (range, 1-11) from their initial urodynamic evaluation. Of them, 33 (66%) remained symptomatic and 1 (34%) normalized. A total of 31 were found to have uninhibited bladder contractions (UBCs) with daytime wetting, of which 24 (77.4%) failed to normalize (P = .037). All 9 with UBCs and detrusor-sphincter dyssynergia remained symptomatic (P = .02).
The majority failed to resolve their voiding symptoms. Children who presented with daytime wetting, UBC, and detrusor-sphincter dyssynergia were the most likely to remain symptomatic. Patients with these characteristics might be considered for more aggressive alternative therapies, after a period of medical management.
通过分析患者的临床表现和影像尿动力学检查结果，确定哪些因素可能会导致部分患者最终无法缓解排尿症状。对于那些存在难治性排尿功能障碍且无神经异常证据的大龄儿童，在药物治疗无效的情况下，如何进行管理是一个挑战。
回顾了 50 例存在难治性排尿功能障碍且影像尿动力学检查正常和腰骶部磁共振成像正常的神经正常儿童的病历。创建了一个数据库，其中包含尿动力学检查、主要的排尿症状、有无粪便污染或便秘、症状发作年龄、膀胱造影和超声检查结果以及所给予的治疗。通过病历回顾（所有患者）或邮寄问卷调查（15 例患者）确定长期随访结果。没有症状且停药的患者定义为正常。
共有 50 例患者符合前文所述的标准，平均年龄为 9.4 岁（范围，3.8-17.3 岁），从最初的尿动力学评估开始平均随访 4 年（范围，1-11 年）。其中，33 例（66%）仍有症状，1 例（34%）正常。31 例存在日间遗尿伴无抑制性膀胱收缩，其中 24 例（77.4%）未恢复正常（P =.037）。所有 9 例存在无抑制性膀胱收缩和逼尿肌-括约肌协同失调的患者均持续有症状（P =.02）。
大多数患者的排尿症状未得到缓解。日间遗尿、无抑制性膀胱收缩和逼尿肌-括约肌协同失调的患者最有可能持续存在症状。对于这些特征的患者，在经过一段时间的药物治疗后，可考虑采用更积极的替代治疗方法。
