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多发性硬化症患儿的下尿路功能障碍:诊断与管理问题

Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns.

作者信息

Sollini Maria Laura, Pellegrino Chiara, Barone Giulia, Capitanucci Maria Luisa, Zaccara Antonio Maria, Crescentini Leonardo, Castelli Enrico, Della Bella Gessica, Scorletti Federico, Papetti Laura, Monte Gabriele, Ferilli Michela Ada Noris, Valeriani Massimiliano, Mosiello Giovanni

机构信息

Division of Neuro-Urology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.

Clinical Science and Translational Medicine, Tissue Engineering and Remodeling Biotechnologies for Body Function PhD School, University of Rome Tor Vergata, Via Cracovia 50, 00133 Rome, Italy.

出版信息

Children (Basel). 2024 May 16;11(5):601. doi: 10.3390/children11050601.

Abstract

BACKGROUND

Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children.

METHODS

This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams.

RESULTS

We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed.

CONCLUSIONS

The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.

摘要

背景

儿童多发性硬化症(MS)的发病率正在上升,与成人一样,患者的症状各不相同。在儿童中,最初的表现有时可能与急性神经症状重叠。儿童期的泌尿系统症状尚未得到充分研究。我们分享了我们在儿童MS泌尿系统表现方面的经验。

方法

本文是对所有符合Krupp标准且伴有泌尿系统症状的MS儿童进行的回顾性评估。我们收集了人口统计学和临床病史、脱髓鞘病变的磁共振成像定位、泌尿系统症状及检查结果。

结果

我们报告了6例有泌尿系统表现的MS儿童病例。泌尿系统症状以5例尿失禁和1例尿潴留为特征,出现在与MS诊断不同的时间框架内。尿动力学检查显示膀胱过度活动和活动不足两种模式。根据下尿路功能障碍进行治疗,采用清洁间歇性导尿、奥昔布宁和膀胱逼尿肌内注射A型肉毒杆菌毒素。观察到侵入性评估和泌尿系统管理的接受率较低。

结论

MS诊断对我们所有患者来说都是一次创伤。我们认为从诊断之时起就对年轻人进行泌尿系统护理以进行及时管理很重要;让小儿泌尿科医生加入多学科团队可能会有所帮助。

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