接受膀胱扩大术的神经源性膀胱儿童和青少年的临床及尿动力学研究结果：一项系统评价
Clinical and urodynamic findings in children and adolescents with neurogenic bladder undergoing augmentation cystoplasty: a systematic review.
作者信息
Reis Otávio Augusto Fonseca, Ito Hilton Naoto, de Oliveira Otávio Juliana, de Oliveira Filho Diniz José, Lima Eleonora Moreira, de Bessa José, da Silva Paula Larissa Lebron, de Almeida Vasconcelos Mônica Maria, de Carvalho Mrad Flávia Cristina
机构信息
Faculty of Medicine, Department of Pediatric, Pediatric Nephrology Unit, Hospital das Clínicas (UFMG), Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, 30130-100, Brazil.
Urology Unit, Hospital Felicio Rocho, Belo Horizonte, Brazil.
出版信息
Pediatr Nephrol. 2025 Feb;40(2):355-365. doi: 10.1007/s00467-024-06499-y. Epub 2024 Sep 9.
BACKGROUND
Augmentation cystoplasty (AC) is a procedure to improve the clinical and urodynamic parameters of neurogenic bladder (NB) in children and adolescents refractory to other treatments. We performed a systematic review to investigate these parameters in children and adolescents with NB undergoing AC.
METHODS
We followed PRISMA guidelines and searched electronic databases until March 2024 for studies involving patients aged three to 19 years diagnosed with NB undergoing AC. We assessed clinical and urodynamic parameters before and after surgery, focusing on improvements in urinary incontinence, vesicoureteral reflux (VUR), bladder capacity, compliance, and end filling detrusor pressure (EFP).
RESULTS
A total of 212 NB patients underwent AC and were evaluated for urinary incontinence before and after surgery. Two studies showed a 76.5% to 78.9% improvement in incontinence without bladder outlet procedures (BOP). Another study found no significant difference in incontinence improvement rates between AC with and without BOP. The VUR resolution rate assessed in three studies ranged from 12.5 to 64%. Three studies showed a variation in bladder capacity from 52.8 to 70% of the expected bladder capacity pre-AC to 95.9 to 119%, post-AC. A fourth study showed a variation in bladder capacity from 87 ml pre-AC to 370 ml post-AC. Two studies showed a variation from 3.2 to 4.6 ml/cm HO pre-AC to 13.7 to 41.3 ml/cm HO post-AC in bladder compliance. The EFP in three studies varied from 37.2 to 47.6 cm HO pre-AC to 11 to 17.4 cm HO post-AC.
CONCLUSION
After AC, urinary incontinence, bladder capacity, EFP, and bladder compliance improved in children and adolescents with NB.
背景
膀胱扩大术（AC）是一种用于改善对其他治疗无效的儿童和青少年神经源性膀胱（NB）的临床和尿动力学参数的手术。我们进行了一项系统评价，以研究接受AC治疗的NB儿童和青少年的这些参数。
方法
我们遵循PRISMA指南，检索电子数据库至2024年3月，以查找涉及3至19岁被诊断为NB并接受AC治疗的患者的研究。我们评估了手术前后的临床和尿动力学参数，重点关注尿失禁、膀胱输尿管反流（VUR）、膀胱容量、顺应性和充盈末期逼尿肌压力（EFP）的改善情况。
结果
共有212例NB患者接受了AC治疗，并在手术前后对尿失禁进行了评估。两项研究表明，在未进行膀胱出口手术（BOP）的情况下，尿失禁改善率为76.5%至78.9%。另一项研究发现，进行BOP和未进行BOP的AC患者在尿失禁改善率方面没有显著差异。三项研究评估的VUR缓解率在12.5%至64%之间。三项研究表明，膀胱容量从AC术前预期膀胱容量的52.8%至70%变化至AC术后的95.9%至119%。第四项研究表明，膀胱容量从AC术前的87毫升变化至AC术后的370毫升。两项研究表明，膀胱顺应性从AC术前的3.2至4.6毫升/厘米水柱变化至AC术后的13.7至41.3毫升/厘米水柱。三项研究中，EFP从AC术前的37.2至47.6厘米水柱变化至AC术后的11至17.4厘米水柱。
结论
AC术后，NB儿童和青少年的尿失禁、膀胱容量、EFP和膀胱顺应性均有所改善。
Zotero 插件