脊髓裂患者过渡到成人护理的泌尿科问题。

Urologic problems in spina bifida patients transitioning to adult care.

机构信息

Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT; Division of Urology, Department of Surgery, the Primary Children's Medical Center, University of Utah, Salt Lake City, UT; Department of Urology, Children's Hospitals and Clinics of Minnesota, University of Minnesota, Minneapolis, MN.

出版信息

Urology. 2014 Aug;84(2):440-4. doi: 10.1016/j.urology.2014.03.041.

DOI:10.1016/j.urology.2014.03.041

PMID:25065990

Abstract

OBJECTIVE

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems.

METHODS

We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions.

RESULTS

We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems.

CONCLUSION

On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

摘要

目的

确定在从儿科过渡到成人护理时，患有脊髓脊膜膨出（SB）的成年患者的泌尿科需求。我们假设，向成人护理的过渡延迟与更高的活动问题发生率有关。

方法

我们回顾性地审查了 2011 年 4 月至 2012 年 4 月期间在犹他大学和明尼苏达大学的成人 SB 专科诊所就诊的患者。我们审查了膀胱管理、泌尿科问题、上次泌尿科护理的时间以及必要的干预措施。

结果

我们从这些诊所中确定了 65 名患有 SB 的患者。平均年龄为 30.6 岁（标准差 11.3）。犹他州和明尼苏达州的最后一次泌尿科评估的中位数时间分别为 17 个月和 12 个月（范围为 1 个月至 10 年）。55 名患者（85％）在就诊时报告存在泌尿科问题。尿失禁最为常见，有 34 例（52％），其次是复发性尿路感染 22 例（34％），导尿困难 8 例（12％）和结石 6 例（9％）。63 名患者（97％）需要某种干预措施。这些干预措施包括诊断性（膀胱镜检查、超声检查、计算机断层扫描、尿动力学检查）50 例（77％）、手术性（尿流改道、肉毒杆菌毒素 A 注射、结石手术等）22 例（34％）和药物治疗（抗生素预防、膀胱冲洗、抗胆碱能药物、自我导尿）16 例（25％）。过渡时间较长与活动问题发生率较高之间没有关联。