Onishi N, Uchida A, Kiwamoto H, Esa A, Sugiyamka T, Park Y, Akiyama T, Kurita T
Department of Urology, Kinki University, School of Medicine, Osaka, Japan.
Nihon Hinyokika Gakkai Zasshi. 1991 Mar;82(3):473-80. doi: 10.5980/jpnjurol1989.82.473.
We studied 20 cases of neurogenic bladder with vesico-ureteral reflux retrospectively. Seven patients voided with Valsalva's maneuver and 12 patients were managed with clean intermittent catheterization, but one patient required permanent urinary diversion because of uncontrollable urinary tract infection. The patients were followed by intravenous pyelography, radioisotope renogram, voiding cystourethrography, determination of serum creatinine level and urodynamic study. Anti-reflux surgery was performed in 22 ureters and reflux resolved in 19 ureters. Among 12 ureters not treated by anti-reflux surgery, reflux disappeared in 5 ureters and improved in 2 ureters. Of 5 ureters, reflux resolved after clean intermittent catheterization in 2 ureters, and remained stable without recurrent infection or renal deterioration in the remaining 5 ureters. Regardless whether antireflux surgery was done or not, most of the patients who had high grade reflux and obstructive renal damage on radioisotope examinations had marked low compliance bladders. Our experience suggested the necessity of a suitable treatment to improve bladder compliance before considering anti-reflux surgery.
我们回顾性研究了20例伴有膀胱输尿管反流的神经源性膀胱患者。7例患者通过瓦尔萨尔瓦动作排尿，12例患者采用清洁间歇性导尿法处理，但有1例患者因无法控制的尿路感染而需要永久性尿流改道。通过静脉肾盂造影、放射性核素肾图、排尿性膀胱尿道造影、血清肌酐水平测定和尿动力学研究对患者进行随访。对22条输尿管实施了抗反流手术，其中19条输尿管的反流得到解决。在未接受抗反流手术治疗的12条输尿管中，5条输尿管的反流消失，2条输尿管的反流有所改善。在这5条输尿管中，2条输尿管在清洁间歇性导尿后反流得到解决，其余5条输尿管的反流保持稳定，无反复感染或肾脏恶化。无论是否进行抗反流手术，放射性核素检查显示有高度反流和梗阻性肾损害的大多数患者膀胱顺应性明显较低。我们的经验表明，在考虑抗反流手术之前，有必要采取适当的治疗措施来提高膀胱顺应性。
