Brodak P P, Scherz H C, Packer M G, Kaplan G W
Department of Pediatric Urology, Children's Hospital and Health Center, San Diego, California.
J Urol. 1994 Nov;152(5 Pt 1):1586-7. doi: 10.1016/s0022-5347(17)32481-3.
Patients with cerebral palsy are prompted to seek urological evaluation when urinary tract infection, socially unacceptable incontinence or hematuria occurs. We attempted to determine the prevalence of urinary tract structural changes by prospectively screening on sonography the kidneys and bladder of 90 patients 1 to 25 years old (mean age 8 years) who had cerebral palsy with or without urological symptoms. Uncooperative patients or those who would require sedation were excluded. Of the patients 66 were incontinent and used diapers, 18 were completely dry and 6 had nocturnal enuresis with daytime dryness. Sonographic abnormalities were detected in 7 patients, including renal size discrepancy in 2 (1 with severe scoliosis and 1 with a history of renal artery thrombosis), mild to moderate hydronephrosis with thickened bladders suggestive of neurogenic bladder dysfunction in 3 and a nonvisualized kidney in 2. However, repeat sonography confirmed 2 normal kidneys in the latter patients. Thus, urinary tract abnormalities were detected unexpectedly in 2% of patients studied. This relatively low proportion suggests that routine urinary tract screening in cerebral palsy patients may not be warranted.
当脑瘫患者出现尿路感染、社交上难以接受的尿失禁或血尿时，会被促使去寻求泌尿外科评估。我们试图通过前瞻性超声检查90名1至25岁（平均年龄8岁）有或无泌尿系统症状的脑瘫患者的肾脏和膀胱，来确定泌尿系统结构改变的患病率。不合作的患者或需要镇静的患者被排除在外。在这些患者中，66名患者尿失禁且使用尿布，18名患者完全干爽，6名患者夜间遗尿但白天干爽。7名患者检测到超声异常，包括2名患者肾脏大小不一（1名患有严重脊柱侧凸，1名有肾动脉血栓形成病史），3名患者有轻度至中度肾积水且膀胱增厚提示神经源性膀胱功能障碍，2名患者一侧肾脏未显影。然而，后两名患者再次超声检查证实双肾正常。因此，在所研究的患者中，意外发现2%的患者存在泌尿系统异常。这一相对较低的比例表明，脑瘫患者可能没有必要进行常规泌尿系统筛查。
