Takechi S, Nishio S, Yokoyama M, Iwata H, Takeuchi M
Department of Urology, Ehime University School of Medicine, Japan.
Nihon Hinyokika Gakkai Zasshi. 1995 Oct;86(10):1520-4. doi: 10.5980/jpnjurol1989.86.1520.
For neurogenic bladder (NGB) patients with vesicoureteral reflux (VUR), renal deterioration constitutes a primary threat to survival. Although anti-reflux surgery for those patients was reported to be effective, the efficacy of clean intermittent catheterization (CIC) in such patients still remains to be clarified.
Sixteen neurogenic bladder patients with VUR were treated with CIC. Eight of them had spina bifida and 3 had radical hysterectomy for uterine cancer. Other 5 patients had spinal cord injury, spondyrocace, measles encephalopathy, and 2 unknown diseases, respectively. Hyperactive bladder was noted in 11 patients, whereas hypoactive bladder was noted in 3. Three patients were not evaluated.
VUR was improved in only 3 patients (3 ureters), whose VUR grades were not more than III. Nine patients (13 ureters) had to have antireflux surgery. Although 3 of them needed bladder augmentation afterwards, the success rate of the antireflux surgery was 84.6%.
We concluded that CIC alone was not effective to control VUR in neurogenic bladder patients. Nevertheless, CIC remained a good treatment option when VUR was managed surgically.
对于患有膀胱输尿管反流（VUR）的神经源性膀胱（NGB）患者，肾脏恶化是对其生存的主要威胁。尽管据报道抗反流手术对这些患者有效，但清洁间歇性导尿（CIC）在此类患者中的疗效仍有待阐明。
16例患有VUR的神经源性膀胱患者接受了CIC治疗。其中8例患有脊柱裂，3例因子宫癌接受了根治性子宫切除术。其他5例患者分别患有脊髓损伤、脊椎炎、麻疹性脑病和2种不明疾病。11例患者表现为膀胱过度活动，3例表现为膀胱活动低下。3例患者未进行评估。
仅3例患者（3条输尿管）的VUR得到改善，其VUR分级不超过III级。9例患者（13条输尿管）不得不接受抗反流手术。尽管其中3例患者术后需要膀胱扩大术，但抗反流手术的成功率为84.6%。
我们得出结论，单纯CIC对控制神经源性膀胱患者的VUR无效。然而，当通过手术治疗VUR时，CIC仍然是一种很好的治疗选择。
