Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France.
Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France.
J Pediatr Urol. 2021 Aug;17(4):526.e1-526.e6. doi: 10.1016/j.jpurol.2021.05.019. Epub 2021 May 26.
INTRODUCTION/BACKGROUND: Urinary incontinence is common in children with neuropathic bladder. Results of endoscopic injections of bulking agents in the bladder neck are promising but it remains unclear whether they should be performed an antegrade or retrograde fashion.
Our aim was to compare the antegrade and retrograde endoscopic injection techniques for the treatment of urinary incontinence.
A prospective study evaluating bladder neck dextranomer-hyaluronic acid polymer injections for urinary incontinence in children with neurogenic bladder was initiated in 1997. Children with normal bladder capacity and compliance and without uncontrolled detrusor overactivity or previous bladder neck surgery were included. Patients were classified as success (dry or significantly improved, the latter defined as no need for more than one pad per day, continent during night, and patient seeking no further treatment) or failure at regular follow-up visits.
During 1997-2016, 34 children underwent endoscopic treatment in a retrograde while 17 children in antegrade fashion (mean age 11 years, range 5-20). Most patients (n = 47/51) had neuropathic bladder due to congenital malformations, 13 (25%) had had previous bladder augmentation, and 19 (37%) were in wheelchair. Sex, age, etiology of neurogenic bladder, degree of physical impairment, or era of treatment (1997-2012 vs. 2012-2016) had no influence on success rates (Summary Table). After mean follow-ups of 69 (range 12-156) months, success rates were 71% for the antegrade and 53% for the retrograde technique (p = 0.366). Mean number of injections to obtain success was similar between the techniques (1.4 vs. 1.2). While the proportion of dry patients was similar between the two techniques (35%), the proportion of significantly improved patients tended to be higher after antegrade than retrograde injections (35% vs. 18%, p = 0.181).
Better visualization of the bladder neck may explain the tendency for improved results of antegrade compared to retrograde technique. Further studies in larger patient samples are needed to define the optimal endoscopic injection technique.
Long-term results of the antegrade endoscopic bladder neck injections of dextranomer-hyaluronic acid polymer for urinary incontinence in children with neurogenic bladder are promising.
简介/背景：神经源性膀胱患儿常出现尿失禁。经内镜膀胱颈部注射填充剂的疗效令人鼓舞，但目前尚不清楚应采用顺行还是逆行方式进行。
我们旨在比较顺行和逆行内镜注射技术治疗神经源性膀胱尿失禁的效果。
1997 年启动了一项前瞻性研究，评估神经源性膀胱患儿膀胱颈部葡聚糖-透明质酸钠聚合物注射治疗尿失禁的效果。纳入标准为膀胱容量和顺应性正常、无不可控逼尿肌过度活动或既往膀胱颈部手术史的患儿。定期随访时将患儿分为成功（无尿失禁或明显改善，后者定义为每天无需使用超过 1 片尿垫，夜间控尿，且患儿不再寻求进一步治疗）或失败。
1997 年至 2016 年间，34 例患儿接受逆行内镜治疗，17 例患儿接受顺行内镜治疗（平均年龄 11 岁，范围 5-20 岁）。大多数患儿（n=47/51）因先天性畸形导致神经源性膀胱，13 例（25%）曾行膀胱扩大术，19 例（37%）需坐轮椅。性别、年龄、神经源性膀胱病因、身体损伤程度或治疗时间（1997-2012 年 vs. 2012-2016 年）对成功率均无影响（汇总表）。平均随访 69（范围 12-156）个月后，顺行和逆行技术的成功率分别为 71%和 53%（p=0.366）。两种技术获得成功所需的注射次数相似（1.4 次 vs. 1.2 次）。两种技术的干燥患者比例相似（35%），但顺行注射后显著改善患者的比例高于逆行注射（35% vs. 18%，p=0.181）。
更好地观察膀胱颈部可能解释了顺行技术优于逆行技术的结果趋势。需要进一步的大样本患者研究来确定最佳内镜注射技术。
顺行内镜膀胱颈部注射葡聚糖-透明质酸钠聚合物治疗神经源性膀胱尿失禁的长期结果令人鼓舞。
