Teichman J M, Scherz H C, Kim K D, Cho D H, Packer M G, Kaplan G W
Department of Pediatric Urology, Children's Hospital, San Diego, California.
J Urol. 1994 Aug;152(2 Pt 2):807-11. doi: 10.1016/s0022-5347(17)32716-7.
We have adopted an approach to the management of myelodysplasia patients which is contrary to that most commonly supported by the existing literature. We screen patients shortly after birth with ultrasound, urine culture and serum creatinine, and then follow patients at 3 to 6-month intervals with similar studies. Cystography and urodynamics are done only as required clinically or by a change in the sonogram. Clean intermittent catheterization is indicated for continence or medical reasons. With this approach of aggressive observation and prompt intervention, we observed a rate of renal deterioration (diminished function on renal scan or parenchymal loss on imaging studies) of 5%. Renal deterioration was associated statistically with urinary tract infections and reflux. Patients started on clean intermittent catheterization for medical indications had greater risk for renal deterioration than those started on it for continence. Renal deterioration occurred with equal frequency between patients with abnormal and normal urodynamic studies, that is urodynamics did not predict renal deterioration. Our data show a rate of renal deterioration similar to other reports. We believe that aggressive observation with prompt intervention for problems once identified represents a reasonable alternative to managing patients with myelodysplasia.
我们采用了一种与现有文献中最常支持的方法相反的骨髓发育异常患者管理方法。我们在患者出生后不久用超声、尿培养和血清肌酐进行筛查，然后每隔3至6个月用类似的检查对患者进行随访。膀胱造影和尿动力学检查仅在临床需要或超声检查结果有变化时进行。清洁间歇性导尿适用于控制排尿或出于医疗原因。通过这种积极观察和及时干预的方法，我们观察到肾脏恶化率（肾扫描显示功能减退或影像学研究显示实质损失）为5%。肾脏恶化在统计学上与尿路感染和反流相关。因医疗指征开始进行清洁间歇性导尿的患者比因控制排尿开始导尿的患者发生肾脏恶化的风险更高。尿动力学检查异常和正常的患者肾脏恶化发生率相同，也就是说尿动力学检查不能预测肾脏恶化。我们的数据显示肾脏恶化率与其他报告相似。我们认为，一旦发现问题就进行积极观察并及时干预，是管理骨髓发育异常患者的一种合理替代方法。
