Tan P K, Edmond P
Queen Elizabeth National Spinal Centre, Southern General Hospital, Glasgow, UK.
J R Coll Surg Edinb. 1994 Oct;39(5):307-9.
An audit was performed on 17 patients with neuropathic bladders managed on longterm indwelling urethral catheters with a duration of at least eight years. The accumulated duration of continuous catheterization of this study group was at least 231 man years. The effects on the upper urinary tracts were studied by annual imaging alternating between limited intravenous urograms and ultrasonography, together with serum creatinine estimations. A grading system for upper tract changes was introduced. About a quarter of the patients on indwelling urethral catheter drainage developed early calyceal dilatation. Three patients were converted to suprapubic catheterization and three had ileoconduit diversion. The reasons were analysed. Although urine cultures were consistently positive with mixed organisms, all instances of clinical urinary tract infections were easily controlled by short courses of antibiotics. In six patients who had cystoscopic examinations, no tumour transformations were noted. Other complications encountered included bladder stones (2), clinically significant urethral fissuring (1) and bleeding per urethra (1). The three considerations for prescribing bladder management are discussed. With good catheter management and regular changes, we conclude that indwelling urethral catheter is a serious option for longterm drainage of neuropathic bladders.
对17例长期留置导尿管（留置时间至少8年）治疗神经源性膀胱的患者进行了一项审计。该研究组的累计持续导尿时间至少为231人年。通过每年交替进行有限静脉肾盂造影和超声检查以及血清肌酐估计来研究对上尿路的影响。引入了上尿路变化的分级系统。约四分之一留置导尿管引流的患者出现早期肾盏扩张。3例患者改为耻骨上膀胱造瘘术，3例进行回肠代膀胱术，并分析了原因。尽管尿培养始终显示混合菌阳性，但所有临床尿路感染病例均通过短期抗生素治疗得到轻松控制。在6例接受膀胱镜检查的患者中，未发现肿瘤转化。遇到的其他并发症包括膀胱结石（2例）、具有临床意义的尿道裂伤（1例）和尿道出血（1例）。讨论了膀胱管理处方的三个考虑因素。通过良好的导管管理和定期更换，我们得出结论，留置导尿管是神经源性膀胱长期引流的一个重要选择。
