Batista Miranda J E, Arañó Bertran P, Caffaratti J, Regalado Pareja R, Garat Barredo J M, Errando Smet C, Vicente Rodríguez J
Unidad de Urodinamia, Fundación Puigvert, Barcelona.
An Esp Pediatr. 1997 Sep;47(3):251-7.
The purpose of this study was to assess the urodynamic (UD), radiological (VCUG) and clinical outcome in patients with detrusor instability (DI) and vesico-ureteral reflux (VUR).
UD and VCUG findings in 24 patients between 4 and 18 years of age (mean 7.6 years) with a simultaneous diagnosis of VUR and DI were reviewed. All presented with recurrent urinary tract infections (UTI). Twenty were female of whom 8 also had enuresis and daytime symptoms. Ten had bilateral VUR, making a total of 34 units. Mean follow-up was 40 months (range 18-97 months) and at least 2 UD studies were done. Treatment consisted of oxybutinin chloride (OC) and chemoprophylaxis.
Treatment lasted an average of 31 months with an average dose of 11 mg/day. There was a statistically significant improvement in UTI rate, enuresis score and UD parameters [CysCap, volume at 1st contraction, maximum contraction and compliance (comp)]. Thirteen patients achieved stable bladders and 9 had some UD improvement (3 with low compliance and 2 with less severe DI), leaving 2 with unchanged DI. Reflux disappeared in 20 units and was downgraded in 6. VUR improvement coincided with the cases of UD improvement. Persistence of DI was always associated with persistent VUR.
Oxybutinin treatment can be long, but UD and VUR improvement run parallel in most cases. The rare discrepant cases point towards a multifactorial ethology in this condition.
本研究旨在评估逼尿肌不稳定（DI）合并膀胱输尿管反流（VUR）患者的尿动力学（UD）、放射学（排尿性膀胱尿道造影，VCUG）及临床结局。
回顾性分析24例年龄在4至18岁（平均7.6岁）同时诊断为VUR和DI的患者的UD及VCUG检查结果。所有患者均有复发性尿路感染（UTI）。其中20例为女性，8例还伴有遗尿及日间症状。10例为双侧VUR，共计34个单位。平均随访40个月（范围18 - 97个月），且至少进行了2次UD检查。治疗包括使用氯化奥昔布宁（OC）及化学预防。
治疗平均持续31个月，平均剂量为11毫克/天。UTI发生率、遗尿评分及UD参数[膀胱顺应性（CysCap）、首次收缩时的容量、最大收缩及顺应性（comp）]有统计学显著改善。13例患者膀胱功能稳定，9例患者UD有一定改善（3例顺应性低，2例DI较轻），2例DI无变化。20个单位的反流消失，6个单位的反流程度减轻。VUR改善与UD改善的病例相符。DI持续存在总是与VUR持续存在相关。
奥昔布宁治疗疗程可能较长，但在大多数情况下UD和VUR的改善是并行的。罕见的不一致病例提示该病症存在多因素病因。
