Migúelez Lago C, García Mérida M, Galiano Duro E, Castilla García R, Rius Díaz F, Martínez Valverde A
Sección de Urología Pediátrica, Hospital Materno-Infantil, Málaga, España.
Arch Esp Urol. 1998 Jul-Aug;51(6):605-15.
Neurogenic bladder (NB) frequently causes incomplete bladder emptying, which can lead to deterioration of the upper urinary tract (UUT), vesico-renal reflux (VRR) and incontinence. The aim of this study is to determine the degree of acceptance, performance and results of treatment of NB in children by intermittent catheterization (IC).
Of 121 children (50 girls and 38 boys) with NB, 88 were managed by intermittent catheterization. The mean age at treatment was 5.2 years (range 20 days-13 years). PVC catheters were employed and reutilized for 3 or 4 weeks. Catheters were aseptic but not sterile. Antimicrobial prophylactic therapy was not administered except in patients with VRR. The statistical study was descriptive and results were compared using the Pearson chi square test.
90% had 4 or more catheterizations daily. Family and patient cooperation was good in 90% of the cases. Patients were managed by IC for a mean period of 4 years (range 1 month-14 years). Only two cases (2%) showed mild, transient complications (urethral pain and cystitis). Normal UUT remained normal in 85%; 45% with compromised UUT improved and 7% became worse. Of the children with no VRR, 94% did not develop this complication; VRR resolved in 72% of the cases (24% by IC alone and 48% with drugs or surgery). Only 12% were continent for more than 3 hours, which increased to 77% (64% by IC alone and 86% with drug therapy or surgery). Urethral sphincter urodynamics was the most important prognostic factor: patients with a lower urethral resistance showed better results for the UUT (p = 0.00373) and VRR (p = 0.00943). The results were also better in patients with normal UUT (p = 0.0003) and no VRR (p = 0.009).
IC is not limited by patient age, sex or sociocultural level. It preserves normal TUS and prevents VRR when instituted early, on demonstrating residual urine and high urethral resistance. IC alone or in combination with other treatments is the basic therapy in NB.
神经源性膀胱（NB）常导致膀胱排空不全，进而可导致上尿路（UUT）恶化、膀胱输尿管反流（VRR）和尿失禁。本研究的目的是确定间歇性导尿（IC）治疗儿童NB的接受程度、实施情况及治疗结果。
121例NB患儿（50例女孩，38例男孩）中，88例采用间歇性导尿治疗。治疗时的平均年龄为5.2岁（范围20天至13岁）。使用聚氯乙烯导管，并重复使用3或4周。导管为无菌但非灭菌的。除VRR患者外，未进行抗菌预防治疗。统计学研究为描述性研究，结果采用Pearson卡方检验进行比较。
90%的患儿每天导尿4次或更多。90%的病例中家庭和患儿合作良好。患儿接受IC治疗的平均时间为4年（范围1个月至14年）。仅2例（2%）出现轻度、短暂并发症（尿道疼痛和膀胱炎）。85%的UUT正常者保持正常；45%的UUT受损者病情改善，7%的病情恶化。在无VRR的患儿中，94%未发生该并发症；72%的病例VRR得到解决（24%仅通过IC解决，48%通过药物或手术解决）。仅12%的患儿能保持3小时以上的干爽，这一比例在联合药物治疗或手术时升至77%（仅IC治疗时为64%，联合药物治疗或手术时为86%）。尿道括约肌尿动力学是最重要的预后因素：尿道阻力较低的患儿UUT（p = 0.00373）和VRR（p = 0.00943）的治疗效果更好。UUT正常（p = 0.0003）和无VRR（p = 0.009）的患儿治疗结果也更好。
IC不受患儿年龄、性别或社会文化水平的限制。当早期发现残余尿和高尿道阻力时开始实施IC，可维持正常上尿路状态并预防VRR。IC单独或与其他治疗联合是NB的基本治疗方法。
