遗尿和功能性日间尿失禁的诊断与治疗。
The Diagnosis and Treatment of Enuresis and Functional Daytime Urinary Incontinence.
机构信息
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Saarland University Medical Center, Homburg, Germany Formerly: Department of Pediatrics, Pediatric Nephrology, University Hospital Münster, Münster, Germany.
出版信息
Dtsch Arztebl Int. 2019 Apr 19;116(16):279-285. doi: 10.3238/arztebl.2019.0279.
BACKGROUND
Elimination disorders in childhood are common and treatable. Approximately 10% of 7-year-olds wet the bed at night, and 6% are affected by incontinence during the daytime. Two main types of disturbance are distinguished: nocturnal enuresis and functional (i.e., non-organic) daytime urinary incontinence. Each type contains a wide variety of subtypes. Effective treatment requires precise identification of the subtype of elimination disorder.
METHODS
This review is based on a selection of current publications, including principally the German S2k-AWMF guideline and the recommendations of the International Children's Continence Society (ICCS).
RESULTS
Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. 20-50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. Elements of specific urotherapy are provided only if indicated. For enuresis, the treatment of first choice is alarm therapy, with which 50-70% of the affected children become dry. Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. In intractable cases, training techniques have been found useful.
CONCLUSION
Childhood elimination disorders can be treated effectively after targeted diagnostic evaluation and the establishment of specific indications for treatment. In view of the emotional distress these disorders cause, the associated physical and mental disturbances, and their potential persistence into adolescence, they should be evaluated and treated in affected children from the age of five years onward.
背景
儿童期排泄障碍较为常见且可治疗。约 10%的 7 岁儿童夜间遗尿，6%的儿童日间存在尿失禁。主要区分两种类型的障碍：夜间遗尿和功能性（即非器质性）日间尿失禁。每种类型包含多种亚型。有效的治疗需要精确识别排泄障碍的亚型。
方法
本综述基于当前出版物的选择，主要包括德国 S2k-AWMF 指南和国际儿童尿控协会（ICCS）的建议。
结果
诊断评估重点在于临床症状，是非侵入性的，可在大多数医疗保健环境中进行。如果儿童同时患有多种类型的排泄障碍，则首先治疗粪便失禁或便秘，其次治疗日间尿失禁，最后治疗遗尿。20-50%的排泄障碍儿童存在需要治疗的共病精神障碍。接受标准尿路治疗的日间尿失禁患者中，56%在一年内可达到无尿失禁。这种保守的、以症状为导向的方法包括对患者及其父母进行教育，以促进与饮水和排尿相关的行为改变。只有在必要时才提供特定尿路治疗的内容。对于遗尿，首选治疗方法是报警治疗，约 50-70%受影响的儿童可达到无遗尿。抗利尿激素等药物治疗可以作为辅助治疗。对于难治性病例，训练技术被认为是有用的。
结论
通过有针对性的诊断评估和明确治疗适应证，可有效治疗儿童期排泄障碍。鉴于这些障碍会引起情绪困扰、相关的身心障碍以及其潜在持续至青春期，应从 5 岁起对受影响的儿童进行评估和治疗。
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