Stein M T, Alagiri M, Kohen D P
Division of Primary Care Pediatrics and Adolescent Medicine, School of Medicine, University of California, San Diego, USA.
J Dev Behav Pediatr. 1998 Apr;19(2):105-8. doi: 10.1097/00004703-199804000-00008.
Justin is a 6-year-old boy diagnosed with attention-deficit/hyperactivity disorder who presented with daytime and night-time wetting. He had been toilet trained at the age of 3 years but was back in diapers as a result of the enuresis. His bowel movements were normal. The initial evaluation consisted of a urinalysis, urine culture, serum creatinine level, and renal/bladder ultrasound examination. The urine studies were normal. The serum creatinine level was elevated at 1.0 mg/dL. The ultrasound examination revealed bilateral mild hydronephrosis and a thickened bladder wall. A voiding cystourethrogram was ordered to evaluate anatomy, but Justin would not allow a Foley catheter to be inserted, so the procedure, along with cystoscopy, was performed under anesthesia. Cystoscopy revealed a highly trabeculated bladder, as is seen in either high-grade obstruction or a neurogenic bladder. The cystogram did not show any obstruction or vesicoureteral reflux. Meanwhile, Justin's symptoms continued to increase to the point at which he was constantly wet, and he no longer made any attempts to void on his own. A spinal magnetic resonance imaging study did not show any occult neurologic lesions. Urodynamic studies revealed a high-pressure bladder, poor emptying, and inappropriate voluntary contraction of the striated, urinary sphincter during micturition. Despite institution of anticholinergic medication, psychotherapy, and behavioral therapy, Justin continued to do poorly. He could not tolerate clean intermittent catheterization, and he eventually required a suprapubic tube for urinary drainage and preservation of his kidneys.
贾斯汀是一名6岁男孩，被诊断患有注意力缺陷/多动障碍，同时存在白天和夜间尿床的问题。他在3岁时已完成如厕训练，但由于遗尿又重新使用尿布。他的排便正常。初步评估包括尿液分析、尿培养、血清肌酐水平以及肾脏/膀胱超声检查。尿液检查结果正常。血清肌酐水平升高至1.0毫克/分升。超声检查显示双侧轻度肾积水和膀胱壁增厚。医生安排了排尿性膀胱尿道造影以评估解剖结构，但贾斯汀不允许插入导尿管，因此该检查以及膀胱镜检查在麻醉下进行。膀胱镜检查显示膀胱高度小梁化，这在重度梗阻或神经源性膀胱中可见。膀胱造影未显示任何梗阻或膀胱输尿管反流。与此同时，贾斯汀的症状持续加重，发展到他一直处于尿床状态，并且不再尝试自主排尿。脊髓磁共振成像检查未发现任何隐匿性神经病变。尿动力学研究显示膀胱压力高、排空不良，以及排尿时尿道外括约肌不适当的自主收缩。尽管采用了抗胆碱能药物治疗、心理治疗和行为治疗，贾斯汀的情况仍然不佳。他无法耐受间歇性清洁导尿，最终需要耻骨上造瘘管进行尿液引流以保护他的肾脏。
