Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Urología Pediátrica, Hospital Universitario La Paz, Madrid, Spain.
Actas Urol Esp (Engl Ed). 2022 Jan-Feb;46(1):28-34. doi: 10.1016/j.acuroe.2021.01.012. Epub 2021 Nov 26.
Clean intermittent catheterization (CIC) and anticholinergic drugs are the mainstay treatment for neuropathic bladder (NB). However, there is not consensus about the time therapy should be started in pediatric patients.
To analyze the impact of early start (first year of life) of CIC and anticholinergic treatment on long-term renal and bladder function. Our hypothesis is that those children who start conservative treatment in the first year of life have better outcome in terms of bladder and renal function and less need of surgical procedures, compared to those who started treatment later in life.
Retrospective study of pediatric patients with NB treated in our hospital (1995-2005) dividing them for comparison in two groups: group 1 started treatment in the first year of life and group 2 between 1 and 5 years old. Collected data included: date of CIC and anticholinergic initiation, presence of VUR or UHN, renal function, UTIs, renal scars, bladder behavior, surgery and urinary continence.
Sixty-one patients were included, 25 in group 1 and 36 in group 2. Initially vesico-ureteral reflux (VUR) and overactive bladders were more frequent in group 2. In group 1 one overactive bladder changed to low compliant and in group 2, one normal bladder and 4 overactive bladders changed. At the end of follow-up there were 11 low compliant bladders in group 1 and 17 in group 2. However, in group 1, only 2 patients required bladder augmentation (BA) while in group 2, 12 patients needed it. At the end of the study only 2 patients in group 2 had slight renal insufficiency.
Patients who started conservative treatment in the first year of life have better long-term outcome in terms of UTI, renal scars and surgical procedures. Even if they initially had low compliant bladders, these patients require less BA.
清洁间歇性导尿（CIC）和抗胆碱能药物是治疗神经源性膀胱（NB）的主要方法。然而，对于儿科患者，何时开始治疗尚未达成共识。
分析早期（生命的第一年）开始 CIC 和抗胆碱能治疗对长期膀胱和肾功能的影响。我们的假设是，与生命后期开始保守治疗的儿童相比，那些在生命的第一年开始接受保守治疗的儿童在膀胱和肾功能方面的结果更好，并且需要手术的可能性更小。
对在我院接受治疗的 NB 儿科患者进行回顾性研究（1995-2005 年），将他们分为两组进行比较：组 1 在生命的第一年开始治疗，组 2 在 1 至 5 岁之间开始治疗。收集的数据包括：CIC 和抗胆碱能药物开始使用的日期、是否存在 VUR 或 UHN、肾功能、UTI、肾瘢痕、膀胱行为、手术和尿控情况。
共纳入 61 例患者，其中组 1 25 例，组 2 36 例。最初，组 2 中更频繁出现膀胱输尿管反流（VUR）和膀胱过度活动症。在组 1 中，1 例膀胱过度活动症变为低顺应性，而在组 2 中，1 例正常膀胱和 4 例膀胱过度活动症变为低顺应性。在随访结束时，组 1 中有 11 例低顺应性膀胱，组 2 中有 17 例。然而，在组 1 中，仅 2 例患者需要膀胱扩大术（BA），而在组 2 中，12 例患者需要。在研究结束时，组 2 中仅 2 例患者有轻度肾功能不全。
在生命的第一年开始保守治疗的患者在 UTI、肾瘢痕和手术方面具有更好的长期结果。即使他们最初有低顺应性膀胱，这些患者也需要较少的 BA。
