Department of Surgery, Division of Urology, Duke Medical Center, Durham, NC, USA.
Department of Surgery, Division of Urology, Duke Medical Center, Durham, NC, USA.
Eur Urol Focus. 2020 Sep 15;6(5):838-867. doi: 10.1016/j.euf.2020.01.003. Epub 2020 Jan 22.
Managing patient and parent expectations regarding urinary and fecal continence is important with congenital conditions that produce neurogenic bladder and bowel dysfunction. Physicians need to be aware of common treatment algorithms and expected outcomes to best counsel these families.
To systematically evaluate evidence regarding the utilization and success of various modalities in achieving continence, as well as related outcomes, in children with neurogenic bladder and bowel dysfunction.
We performed a systematic review of the literature in PubMed/Medline in August 2019. A total of 114 publications were included in the analysis, including 49 for bladder management and 65 for bowel management.
Children with neurogenic bladder conditions achieved urinary continence 50% of the time, including 44% of children treated with nonsurgical methods and 64% with surgical interventions. Patients with neurogenic bowel problems achieved fecal continence 75% of the time, including 78% of patients treated with nonsurgical methods and 73% with surgical treatment. Surgical complications and need for revisions were high in both categories.
Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Surgical intervention can be successful in patients refractory to nonsurgical management, but the high complication and revision rates support their use as second-line therapy. This is consistent with guidelines issued by the International Children's Continence Society.
Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence, and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Most children can be managed without surgery. Patients who do not achieve continence with nonsurgical methods frequently have success with operative procedures, but complications and requirements for additional procedures must be expected.
对于产生神经源性膀胱和肠功能障碍的先天性疾病，管理患者和家长对尿便控的期望非常重要。医生需要了解常见的治疗方案和预期结果，以便为这些家庭提供最佳建议。
系统评估有关实现神经源性膀胱和肠功能障碍儿童控尿的各种方法的利用和成功率，以及相关结局的证据。
我们于 2019 年 8 月在 PubMed/Medline 中进行了系统文献检索。共有 114 篇文献纳入分析，其中膀胱管理 49 篇，肠管理 65 篇。
神经源性膀胱疾病患儿的尿控成功率为 50%，其中非手术治疗者为 44%，手术治疗者为 64%。神经源性肠问题患儿的粪控成功率为 75%，其中非手术治疗者为 78%，手术治疗者为 73%。两类治疗的手术并发症和需要修订的比例都很高。
大约一半的神经源性膀胱功能障碍患儿将实现尿控，大约四分之三的神经源性肠功能障碍患儿将实现粪控。手术干预对非手术治疗抵抗的患者可能成功，但高并发症和修订率支持将其作为二线治疗。这与国际儿童控尿协会发布的指南一致。
大约一半的神经源性膀胱功能障碍患儿将实现尿控，大约四分之三的神经源性肠功能障碍患儿将实现粪控。大多数患儿无需手术即可得到控制。未通过非手术方法实现控尿的患者通常可通过手术获得成功，但必须预料到并发症和对进一步治疗的需求。
