Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France.
J Urol. 2012 Nov;188(5):1905-9. doi: 10.1016/j.juro.2012.07.016. Epub 2012 Sep 19.
We prospectively evaluated the efficacy of dextranomer/hyaluronic acid based implants for the endoscopic treatment of neurogenic urinary incontinence.
We prospectively studied patients undergoing endoscopic injection of dextranomer/hyaluronic acid for structural incontinence beginning in October 1997. Preoperative evaluation consisted of medical history, incontinence charts, urine culture, urinary tract ultrasound and videourodynamics, which were repeated regularly during followup. At each evaluation patients were classified as cured or significantly improved (treatment success), or not significantly improved (treatment failure). Followup ranged from 1 to 13 years (mean 7.4).
A total of 48 patients 5 to 20 years old with congenital (45 patients) or acquired (3) neurogenic bladder suffering from severe sphincteric incompetence were included. Of the patients 30 underwent 1, 13 underwent 2 and 5 underwent 3 treatment sessions. Mean injected volume was 4.6 ml per session. Five patients had previously undergone bladder neck surgery. Two patients lost to followup in the short term were classified as treatment failures. Of the patients 45 had more than 2 years of followup, of whom 19 (39.6%) were dry, 6 (12.5%) were significantly improved and 23 (47.9%) had no significant improvement observed. Female patients achieved a significantly higher success rate than males (p = 0.05). No significant clinical or urodynamic criterion was predictive of success or failure. Posttreatment bladder deterioration developed in 10 cases (7 successes and 3 failures), which were managed by bladder augmentation.
Endoscopic treatment of neurogenic urinary sphincter insufficiency with dextranomer/hyaluronic acid is effective in half of the patients. Recurrence of incontinence after 1 year is mainly a sign of bladder deterioration.
我们前瞻性评估了葡聚糖/透明质酸基植入物在治疗神经源性尿失禁中的疗效。
我们前瞻性研究了 1997 年 10 月开始接受葡聚糖/透明质酸内镜注射治疗结构性失禁的患者。术前评估包括病史、尿失禁图表、尿液培养、尿路超声和尿动力学检查，在随访期间定期重复进行。每次评估时，患者均被分为治愈或显著改善（治疗成功）或无显著改善（治疗失败）。随访时间为 1 至 13 年（平均 7.4 年）。
共纳入 48 例 5 至 20 岁的先天性（45 例）或获得性（3 例）神经源性膀胱患者，伴有严重的括约肌功能不全。其中 30 例患者接受了 1 次治疗，13 例患者接受了 2 次治疗，5 例患者接受了 3 次治疗。每次治疗的平均注射量为 4.6 毫升。5 例患者曾接受过膀胱颈部手术。2 例短期失访的患者被归类为治疗失败。45 例患者的随访时间超过 2 年，其中 19 例（39.6%）患者无尿失禁，6 例（12.5%）患者显著改善，23 例（47.9%）患者无明显改善。女性患者的成功率明显高于男性（p = 0.05）。没有明确的临床或尿动力学标准可以预测治疗成功或失败。10 例（7 例成功，3 例失败）患者在治疗后出现膀胱恶化，通过膀胱扩大术进行治疗。
用葡聚糖/透明质酸治疗神经源性尿失禁括约肌功能不全，半数患者有效。1 年后再次出现尿失禁主要是膀胱恶化的迹象。
