Larijani Faezeh Javadi, Moghtaderi Mastaneh, Hajizadeh Nilofar, Assadi Farahnak
Department of Pediatrics, Division of Nephrology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Pediatrics, Division of Nephrology, Rush University Medical Center, Chicago, IL, USA.
Int J Prev Med. 2013 Dec;4(12):1359-64.
The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin-A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists.
新生儿神经源性膀胱功能障碍（NBD）最常见的病因是脊髓脊膜膨出。其病理生理学几乎总是涉及膀胱逼尿肌括约肌协同失调（DSD），若不治疗，可对上、下尿路造成严重且不可逆的损害。NBD的早期诊断和恰当处理对于预防肾损害和膀胱功能障碍以及减少未来手术几率至关重要。对受影响新生儿的初步检查包括肾脏和膀胱超声、残余尿量测量、血清肌酐水平测定以及尿动力学研究。当存在肾积水或DSD时，需进行排尿性膀胱尿道造影。治疗的主要目标是预防尿路恶化，并在适当年龄实现自主排尿。对于脊髓脊膜膨出修补术后立即出现高充盈压和排尿压、DSD和/或高级别反流的患儿，采用清洁间歇性导尿（CIC）联合抗胆碱能药物（奥昔布宁）和抗生素治疗。对于对抗胆碱能药物（口服或膀胱内灌注）治疗反应不足或出现明显副作用的患者，向逼尿肌注射肉毒杆菌毒素A是一种安全的替代方法。对于尽管采用了CIC和最大剂量抗胆碱能治疗但仍存在持续性逼尿肌过度活动和/或逼尿肌括约肌协同失调的患者，手术是一种有效的替代方法。患有NBD的儿童需要由多学科团队进行护理，该团队包括儿科医生、神经外科医生、泌尿外科医生、肾病科医生、骨科医生和其他相关医学专家。
