Maison Patrick Opoku Manu, Lazarus John
a Division of Urology , Red Cross War Memorial Hospital, University of Cape Town , Cape Town , South Africa.
Paediatr Int Child Health. 2017 Nov;37(4):280-285. doi: 10.1080/20469047.2017.1351745. Epub 2017 Jul 17.
If untreated, paediatric neurogenic bladder can cause renal failure and urinary incontinence. It is usually caused by neural tube defects such as myelomeningocele. Children with a neurogenic bladder should be monitored from birth and management should aim to preserve renal function and achieve social continence. This article outlines the management options appropriate for these children in resource-poor settings.
In most low- and middle-income countries, a general lack of awareness of the neurological effects on the urinary tract results in late presentation, usually with urological complications even when spina bifida is diagnosed early. Physical examination must include neurological examination for spinal deformities and intact sacral reflexes. About 90% of children with occult spinal dysraphisms will have cutaneous sacral lesions. The work-up includes urinalysis, serial ultrasound of the urinary tracts and urodynamics. Urodynamic assessment is essential for the diagnosis and prognosis of the paediatric neurogenic bladder. In poorly resourced settings, simple eyeball urodynamics can be performed in the absence of a conventional urodynamic set-up.
Clean intermittent catheterisation (CIC), the mainstay of treatment, is most suitable for resource-poor settings because it is effective and inexpensive. Antimuscarinic drugs such as oxybutynin complement CIC by reducing detrusor overactivity. Intravesical injection of Botox and bladder augmentation surgery is required by a small subset of patients who fail to respond to combined CIC and oxybutynin therapy.
Children with neurogenic bladder in resource-poor settings should have early bladder management to preserve renal function and provide social continence.
小儿神经源性膀胱若不治疗，可导致肾衰竭和尿失禁。它通常由神经管缺陷如脊髓脊膜膨出引起。神经源性膀胱患儿应从出生起就进行监测，治疗目标应是保护肾功能并实现社会可接受的控尿。本文概述了在资源匮乏地区适用于这些患儿的治疗选择。
在大多数低收入和中等收入国家，普遍缺乏对神经系统对尿路影响的认识，导致就诊延迟，即使早期诊断出脊柱裂，通常也会出现泌尿系统并发症。体格检查必须包括对脊柱畸形和完整骶反射的神经学检查。约90%的隐性脊柱发育不良患儿会有骶部皮肤病变。检查包括尿液分析、泌尿系统系列超声检查和尿动力学检查。尿动力学评估对小儿神经源性膀胱的诊断和预后至关重要。在资源匮乏的地区，在没有传统尿动力学设备的情况下，可以进行简单的肉眼尿动力学检查。
清洁间歇性导尿（CIC）是主要治疗方法，最适合资源匮乏地区，因为它有效且成本低廉。抗毒蕈碱药物如奥昔布宁通过减少逼尿肌过度活动来辅助CIC。一小部分对CIC和奥昔布宁联合治疗无反应的患者需要膀胱内注射肉毒杆菌毒素和膀胱扩大手术。
资源匮乏地区的神经源性膀胱患儿应尽早进行膀胱管理，以保护肾功能并实现社会可接受的控尿。
