Humblet Martien, Verpoorten Carla, Christiaens Maria-Helena, Hirche Herbert, Jansen Katrien, Buyse Gunnar, van Gool Jan D
Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium.
Neurourol Urodyn. 2015 Apr;34(4):336-42. doi: 10.1002/nau.22560. Epub 2014 Jan 16.
Intravesical instillation of oxybutynin is an accepted and effective treatment in children with neuropathic bladder-sphincter dysfunction, when oral oxybutynin results in inadequate suppression of detrusor overactivity or intolerable side effects. However, as yet no data are available on long-term use and outcome.
A patient cohort with detrusor-sphincter dyssynergia that started oral oxybutynin between 1995 and 1997 was re-evaluated 15 ± 1 years after the switch from oral to intravesical (n = 10), with urodynamic investigations, renal ultrasounds, DMSA-scintigraphy, (51)Cr-EDTA-clearance, and validated questionnaires on incontinence and quality of life.
At follow-up, cystometric bladder capacity (CBC) had increased to the 25-50% percentiles for age, from the 5% percentile; mean end-filling pressure, 24.5 ± 14.4 cm H2O, had returned to the safe zone; bladder compliance expressed as a fraction of normal compliance for age (Wahl units) showed a statistically significant increase. At follow-up, the prevalence of renal scars was 30% (95% CI: 6-65%). Kidney lengths correlated with scarring at DMSA-scintigraphy, (51)Cr-EDTA-clearance did not. In 2 years of oral oxybutynin we documented 10 pyelonephritic episodes, in 15 years of intravesical oxybutynin only three. Urinary continence was reported as satisfying, its impact on quality of life as acceptable.
Percentile charts for cystometric bladder capacity and individual kidney lengths, age-dependent parameters, were invaluable in estimating long-term outcome, and the same goes for bladder compliance in Wahl units. We can conclude that intravesical oxybutynin provided more than adequate suppression of detrusor activity, without side effects, over a period of 15 years.
当口服奥昔布宁抑制逼尿肌过度活动不足或出现无法耐受的副作用时,膀胱内灌注奥昔布宁是治疗神经源性膀胱括约肌功能障碍患儿的一种公认且有效的方法。然而,目前尚无关于长期使用及疗效的数据。
对1995年至1997年间开始口服奥昔布宁、后转为膀胱内灌注奥昔布宁15±1年的逼尿肌-括约肌协同失调患者队列(n = 10)进行重新评估,包括尿动力学检查、肾脏超声、二巯基丁二酸(DMSA)肾动态显像、(51)铬-乙二胺四乙酸(Cr-EDTA)清除率以及关于尿失禁和生活质量的有效问卷。
随访时,膀胱测压容量(CBC)从第5百分位数增加至年龄的第25 - 50百分位数;平均充盈末压力为24.5±14.4 cm H2O,已恢复至安全范围;以年龄正常顺应性分数(瓦尔单位)表示的膀胱顺应性有统计学显著增加。随访时,肾瘢痕患病率为30%(95%可信区间:6 - 65%)。肾脏长度与DMSA肾动态显像的瘢痕形成相关,Cr-EDTA清除率则不然。在口服奥昔布宁的2年中,记录到10次肾盂肾炎发作,在膀胱内灌注奥昔布宁的15年中仅3次。据报告尿失禁情况令人满意,其对生活质量的影响可接受。
膀胱测压容量百分位数图表和个体肾脏长度(年龄相关参数)对评估长期疗效非常重要,以瓦尔单位表示的膀胱顺应性也是如此。我们可以得出结论,在15年的时间里,膀胱内灌注奥昔布宁对逼尿肌活动的抑制作用充分且无副作用。