Steiner G, Müller S C, Brühl P
Klinik und Poliklinik für Urologie, Rheinischen Friedrich-Wilhelms-Universität, Bonn, Deutschland.
Wien Med Wochenschr. 1998;148(13):299-304.
Dysraphic defects may cause neurogenic incontinence in childhood. Constipation and encopresis are often associated. Depending on the involved segment of the spinal cord hyperreflexia or atonia of the detrusor is observed. Similar findings, without anatomic correlation, can be seen in occult-neurogenic voiding dysfunctions. Therapeutic means aim at preservation of kidney function and the best possible continence. If the symptoms cannot be treated by anticholinergic drugs in a low-capacity, hypertonic bladder, augmentation by bowel segments or continent urinary diversion (e.g. Mainz I pouch) is performed. In the last years modalities of clean intermittent self-catheterization in high-capacity, atonic bladders could be enhanced by the development of new atraumatic catheter systems. Urogenital malformation e.g. proximal epispadias and exstrophic bladder can cause incontinence as well. Recently, new therapeutic concepts were introduced. Ectopic ureter (extraurethral incontinence) in girls or posterior urethral valves in boys as a reason for incontinence must not be forgotten.
神经管闭合不全缺陷可能导致儿童神经源性尿失禁。便秘和大便失禁常与之相关。根据脊髓受累节段，可观察到逼尿肌反射亢进或无张力。在隐匿性神经源性排尿功能障碍中也可出现类似表现，但无解剖学关联。治疗手段旨在保护肾功能并尽可能实现控尿。如果在低容量、高张性膀胱中抗胆碱能药物无法治疗症状，则进行肠段扩大或可控性尿流改道（如美因茨I型贮尿囊）。近年来，新型无创导管系统的开发改善了大容量、无张力膀胱的清洁间歇性自我导尿方式。泌尿生殖系统畸形，如近端尿道上裂和膀胱外翻也可导致尿失禁。最近，引入了新的治疗概念。女孩的异位输尿管（尿道外尿失禁）或男孩的后尿道瓣膜作为尿失禁的原因也不应被忽视。
