Ritchey M L, Sinha A, DiPietro M A, Huang C, Flood H, Bloom D A
Department of Surgery, University of Michigan, Ann Arbor.
J Urol. 1994 Aug;152(2 Pt 2):815-8. doi: 10.1016/s0022-5347(17)32718-0.
We reviewed retrospectively 456 patients with diurnal enuresis to determine the relationship between spina bifida occulta and attainment of continence. Of these patients 127 had undergone x-rays of the spine and 48 children (48%) had spina bifida occulta. The clinical course of these patients was compared to 79 enuretic children with normal spine films. All patients were initially treated with a timed voiding program and 28 with persistent enuresis were given anticholinergic medication. Findings on urodynamic studies were similar for both groups. Uninhibited bladder contractions were found in the majority of patients and 2 children in each group had hypertonic filling curves. Of 10 children with spina bifida occulta magnetic resonance imaging or ultrasound of the spine revealed lipoma and tethering of the cord in 1. Mean followup for both groups was 3 years. The outcome for enuretic children with spina bifida occulta was comparable to those with normal spine x-rays. The majority of patients had resolution of the enuresis with conservative management. Spinal ultrasound or magnetic resonance imaging may be warranted in those children with abnormal neurological findings on examination or hypertonic filling curves, or those who fail to respond to medical treatment. However, neurosurgical intervention to achieve continence appears necessary in only a small percentage of enuretic children with spina bifida occulta.
我们回顾性研究了456例日间遗尿症患者，以确定隐性脊柱裂与尿失禁治愈之间的关系。在这些患者中，127例接受了脊柱X光检查，48名儿童（48%）有隐性脊柱裂。将这些患者的临床病程与79例脊柱X光片正常的遗尿儿童进行了比较。所有患者最初均接受定时排尿计划治疗，28例持续性遗尿患者给予抗胆碱能药物治疗。两组患者的尿动力学研究结果相似。大多数患者发现有无抑制性膀胱收缩，每组各有2名儿童出现高张性充盈曲线。在10例隐性脊柱裂患儿中，脊柱磁共振成像或超声检查发现1例存在脂肪瘤和脊髓拴系。两组的平均随访时间均为3年。隐性脊柱裂遗尿儿童的预后与脊柱X光片正常的儿童相当。大多数患者通过保守治疗使遗尿症得到缓解。对于那些检查时有异常神经学表现或高张性充盈曲线的儿童，或对药物治疗无反应的儿童，可能需要进行脊柱超声或磁共振成像检查。然而，只有一小部分隐性脊柱裂遗尿儿童似乎有必要进行神经外科干预以实现尿失禁的治愈。
