McGuire E J, Woodside J R, Borden T A
J Urol. 1983 Apr;129(4):823-6. doi: 10.1016/s0022-5347(17)52384-8.
We report on 6 patients with myelodysplasia who had undergone previously urodynamic evaluation that demonstrated detrusor hypertonia. At the time of the initial studies no patient had vesicoureteral reflux or significant upper urinary tract dilatation. Subsequently, upper urinary tract deterioration and/or vesicoureteral reflux developed in all patients and persisting detrusor hypertonia was demonstrated on followup urodynamic testing. Marked clinical and radiographic improvement followed treatment by intermittent catheterization with concomitant pharmacologic therapy. Our experience indicates that detrusor hypertonia can lead to ureteral complications in patients with previously radiographically normal upper urinary tracts. We believe that detrusor hypertonia should be treated with anticholinergic medication, frequently in conjunction with intermittent catheterization. The clinical presentation of upper tract deterioration after many years of normality, and occurring as late as the mid teenage years, demonstrates that these patients require prolonged and careful urologic and radiographic followup.
我们报告了6例骨髓发育异常患者，他们之前接受过尿动力学评估，结果显示逼尿肌张力亢进。在最初的研究时，没有患者存在膀胱输尿管反流或明显的上尿路扩张。随后，所有患者均出现上尿路恶化和/或膀胱输尿管反流，且在随访尿动力学检查中显示逼尿肌张力亢进持续存在。通过间歇性导尿并辅以药物治疗后，临床和影像学表现有显著改善。我们的经验表明，逼尿肌张力亢进可导致既往上尿路影像学正常的患者出现输尿管并发症。我们认为，逼尿肌张力亢进应使用抗胆碱能药物治疗，通常需结合间歇性导尿。多年正常后出现上尿路恶化的临床表现，甚至在青少年中期才出现，表明这些患者需要长期且仔细的泌尿外科和影像学随访。
