Jørgensen Bettina, Olsen Lars Henning, Jørgensen Troels Munch
Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark.
Scand J Urol Nephrol. 2010 Mar;44(2):95-100. doi: 10.3109/00365590903494916.
This study evaluated the renal and functional outcome in a cohort of adolescents with congenital spinal malformations followed at this department since birth. All patients went through same follow-up and algorithm of intervention during childhood. None of the patients was treated prophylactically, apart from receiving antibiotics.
Sixty children (31 males, 29 females), born in 1989-1995, were evaluated from June 2006 to May 2007. Ultrasound of the bladder and the upper urinary tract was performed in all patients. Surgical and pharmacological intervention, bowel function, faecal and urinary continence were registered. Renal function was assessed by (51)Cr-EDTA and/or MAG-3 scintigraphy in patients who had previously experienced affected renal function or presented with deteriorated bladder function.
Two children died during follow-up. In total, 47 urological procedures were performed in 23 patients. The most frequently conducted procedures were appendicovesicostomy (n = 11) and autoaugmentation (n = 11). Fourteen patients underwent untethering procedures, resulting in improved bladder function in five patients; nine were unaltered. Five patients had a moderate and two a severe decrease in glomerular filtration rate. Eighty-one per cent were performing clean intermittent catheterization, starting at a median age of 3.6 years. Anticholinergics were used in 50%. Sixty-two per cent were totally urine continent, 22% used incontinence pads in case of leakage and 16% were urine incontinent. Two patients had Malone procedures; 29% were using trans-anal irrigation. Eighty-three per cent were totally faecal continent.
Close follow-up and appropriate intervention have improved renal function in children with congenital spinal malformation, but renal deterioration remains a risk. Total faecal and urinary continence could be achieved in 81% and 62%, respectively.
本研究评估了自出生起就在本科室接受随访的一组先天性脊柱畸形青少年的肾脏及功能转归情况。所有患者在儿童期均接受了相同的随访及干预方案。除使用抗生素外，无患者接受预防性治疗。
对1989年至1995年出生的60名儿童（31名男性，29名女性）于2006年6月至2007年5月进行评估。对所有患者均进行了膀胱及上尿路超声检查。记录手术及药物干预情况、肠道功能、粪便及尿液失禁情况。对既往有肾功能损害或膀胱功能恶化的患者，通过（51）铬-乙二胺四乙酸和/或巯基乙酰三甘氨酸闪烁扫描评估肾功能。
随访期间有2名儿童死亡。共有23名患者接受了47次泌尿外科手术。最常进行的手术是阑尾膀胱造口术（n = 11）和自体膀胱扩大术（n = 11）。14名患者接受了脊髓松解手术，其中5名患者膀胱功能改善；9名患者无变化。5名患者肾小球滤过率中度下降，2名患者重度下降。81%的患者从3.6岁开始进行清洁间歇性导尿。50%的患者使用抗胆碱能药物。62%的患者完全控尿，22%的患者在漏尿时使用尿失禁垫，16%的患者尿失禁。2名患者接受了马龙手术；29%的患者使用经肛门冲洗。83%的患者完全控制排便。
密切随访及适当干预改善了先天性脊柱畸形儿童的肾功能，但肾功能恶化仍然是一个风险。分别有81%和62%的患者可实现完全控制排便和排尿。
