Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Gillette Lifetime Clinic, Gillette Specialty Healthcare, St. Paul, Minnesota.
Neurourol Urodyn. 2019 Jan;38(1):165-170. doi: 10.1002/nau.23818. Epub 2018 Sep 24.
Cerebral palsy (CP) is characterized by motor impairments as a result of brain injury during development. Patients can have neurogenic bladder dysfunction and are often unable to catheterize through their native urethra. Catheterizable channel (CC) creation can facilitate clean intermittent catheterization (CIC). We have observed that patients with large capacity, low-pressure bladders can develop de novo neurogenic detrusor overactivity (NDO) postoperatively. We sought to better characterize this finding.
We reviewed the charts of patients 17 years or older with CP seen between 2006 and 2017. Patients undergoing creation of any type of CC without augmentation cystoplasty, due to adequate storage on pre-operative urodynamics (UDS), were included. Pre- and post-operative UDS were reviewed. Frequency of incontinence and use of anticholinergics or intravesical injections of onabotulinum toxin A (Btx) were reviewed.
Eight patients with CP underwent CC creation without augmentation. Preoperatively, six of eight patients were in chronic retention with two others performing CIC. Following CC creation, patients in retention required additional NDO management with anticholinergics, mirabegron, or onabotulinumtoxin A. Among those with complete UDS data, 67% demonstrated lower maximum cystometric capacity postoperatively. Median follow-up was 25 months.
CC creation facilitates CIC in adults with CP who are in chronic retention due to pseudodyssynergia. Despite preoperative UDS suggesting an adequate capacity, low-pressure bladder, such patients often manifest de novo NDO and worsening incontinence upon initiation of CIC after surgery. These findings should be considered when determining whether to perform augmentation at the time of CC in adults with CP.
脑瘫（CP）的特征是由于发育过程中的脑损伤导致运动障碍。患者可能存在神经源性膀胱功能障碍，通常无法通过自身尿道进行导尿。可导尿通道（CC）的创建可以促进间歇性清洁导尿（CIC）。我们观察到，大容量、低压力膀胱的患者术后可能会新发神经源性逼尿肌过度活动（NDO）。我们试图更好地描述这一发现。
我们回顾了 2006 年至 2017 年间就诊的 17 岁及以上 CP 患者的病历。纳入因术前尿动力学（UDS）检查提示有足够的储存功能而无需行膀胱扩大术即可进行任何类型 CC 手术的患者。回顾术前和术后 UDS。评估失禁频率以及抗胆碱能药物或膀胱内注射肉毒杆菌毒素 A（Btx）的使用情况。
8 例 CP 患者行 CC 手术，未行膀胱扩大术。8 例患者中，术前 6 例处于慢性尿潴留，另外 2 例患者行 CIC。CC 手术后，仍处于尿潴留的患者需要使用抗胆碱能药物、米拉贝隆或肉毒杆菌毒素 A 来进行额外的 NDO 治疗。在有完整 UDS 数据的患者中，67%的患者术后最大膀胱容量降低。中位随访时间为 25 个月。
CC 手术可以为因假性协同失调而处于慢性尿潴留的 CP 成年患者提供 CIC。尽管术前 UDS 检查提示有足够的容量和低压力膀胱，但这些患者在术后开始 CIC 后，往往会出现新的 NDO 和失禁加重。在 CP 成年患者中决定是否在 CC 手术时同时行膀胱扩大术时，应考虑这些发现。
