Kopač Matjaž
Department of Nephrology, Division of Pediatrics, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia.
Biomedicines. 2024 Apr 24;12(5):945. doi: 10.3390/biomedicines12050945.
Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, it may cause urinary incontinence, strongly affecting the child's quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity and may be self limiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, neurogenic bladder dysfunction, most often caused by spinal dysraphism, which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. A voiding diary is crucial in the initial evaluation of lower urinary tract function in children.
下尿路功能障碍在临床上很重要，因为它可能导致尿路感染，主要原因是残余尿的积聚，并对肾功能产生不利影响。此外，它可能导致尿失禁，严重影响儿童的生活质量。下尿路功能与肠道功能密切相关，因为便秘通常与膀胱功能障碍同时存在。下尿路与肠道功能之间的相互作用，再加上诸如逼尿肌过度活动和排尿功能障碍等常见情况，需要一种细致入微的诊断方法。逼尿肌过度活动是一种良性但对社会有害的状况，是儿童白天尿失禁的主要原因。它需要与更严重的情况如神经源性膀胱功能障碍或尿道梗阻相鉴别。排尿功能障碍是指排尿时习惯性的括约肌收缩，在患有逼尿肌过度活动的儿童中很常见，可能会自行缓解，但也可能导致残余尿和尿路感染。在严重情况下，它可能类似于神经源性膀胱功能障碍，最常见的原因是脊柱裂，这常常导致反复尿路感染和膀胱内高压，危及肾功能。排尿日记对于儿童下尿路功能的初步评估至关重要。
