Bouchot O, Buzelin J M, Labat J J
Clinique Urologique, CHR, Nantes.
J Urol (Paris). 1988;94(2):83-6.
Pharmacological agents, essentially anticholinergic and alpha-blocking drugs, occupy an important place in the stabilization of congenital neurogenic bladders. In actual fact, the functional characteristics of the detrusor, contractility, compliance and functional capacity, are important factors in the prognosis of these neurogenic bladders, both for the future of the upper urinary tract and for the possibilities of continence. This behaviour of the detrusor may be pharmacologically modified not only by anticholinergic drugs, but also by alpha-blockers due to the adrenergic innervation of foetal bladders by short neurones. This study compared the activity of these 2 drugs prescribed separately over a minimal period of 2 years to 54 children with congenital neurogenic bladder. The amplitude of vesical contraction was reduced in about 75% of cases with both drugs, but this result was obtained more rapidly with anticholinergic drugs than with alpha-blockers. No escape phenomenon over time was observed. Anticholinergic drugs were more effective on phasic contractions while alpha-blockers were more effective on rhythmic contractions. In contrast, they had an insignificant action on hypertonia. The increase in functional vesical capacity was 4 times greater with anticholinergic drugs than with alpha-blockers, possibly because of a simultaneous reduction in peripheral resistance with alpha-blockers.
药理制剂，主要是抗胆碱能药物和α受体阻滞剂，在先天性神经源性膀胱的稳定治疗中占据重要地位。实际上，逼尿肌的功能特性，如收缩性、顺应性和功能容量，对于这些神经源性膀胱的预后是重要因素，这关系到上尿路的未来以及控尿的可能性。由于胎儿膀胱通过短神经元接受肾上腺素能神经支配，逼尿肌的这种行为不仅可以通过抗胆碱能药物进行药理学改变，还可以通过α受体阻滞剂进行改变。本研究比较了这两种药物分别单独给药至少2年对54例先天性神经源性膀胱患儿的疗效。两种药物治疗后约75%的病例膀胱收缩幅度降低，但抗胆碱能药物比α受体阻滞剂更快达到这一效果。未观察到随时间出现的逃逸现象。抗胆碱能药物对相性收缩更有效，而α受体阻滞剂对节律性收缩更有效。相反，它们对张力亢进作用不明显。抗胆碱能药物使膀胱功能容量增加的幅度是α受体阻滞剂的4倍，这可能是因为α受体阻滞剂同时降低了外周阻力。
