Xu Zheming,Tang Daxing.Clinical treatment strategies of vesicoureteral reflux secondary to neurogenic bladder in children[J].Journal of Clinical Pediatric Surgery,2022,21(09):881-885.[doi:10.3760/cma.j.cn101785-202111029-016]
儿童神经源性膀胱继发膀胱输尿管反流的临床治疗策略
- Title:
- Clinical treatment strategies of vesicoureteral reflux secondary to neurogenic bladder in children
- 摘要:
- 神经源性膀胱（neurogenic bladder，NB）是由调节排尿功能的中枢和（或）周围神经系统发生异常而引起的膀胱尿道功能障碍。膀胱输尿管反流（vesicoureteral reflux，VUR）是NB常见的并发症之一。由于继发于NB的VUR病因复杂，且每个致病因素随着病程的进展相互影响并转化。一直以来该疾病的治疗是临床工作的难点。本文概述了NB继发VUR的总体治疗策略，并从原发病治疗、保守治疗及手术治疗三方面介绍了NB继发VUR的具体治疗方法，讨论不同治疗方法的适应证、临床争议点以及应对策略。
- Abstract:
- Neurogenic bladder (NB) is a dysfunction of bladder and urethra caused by abnormal central or/and peripheral nervous system of regulating urinary function. Vesicoureteral reflux (VUR) is one of the most common complications of NB. Since the underlying etiology of VUR secondary to NB is rather complicated and many pathogenic factors affects each other with the progress of the disease, a proper treatment of the disease has always been a clinical dilemma. This review summarized the overall treatment strategies of secondary VUR in NB and focused upon treatment of primary disease, conservative measures and surgery. Also clinical indications for different tretments, current controversies and counter-measures were discussed.
参考文献/References:
[1] 文建国, 李云龙, 袁继炎, 等.小儿神经源性膀胱诊断和治疗指南[J].中华小儿外科杂志, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002. Wen JG, Li YL, Yuan JY, et a1.Guidelines on the diagnosis and management of neurogenic bladder in children[J].Chin J Pediatr Surg, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002.
[2] de Jong TP, Chrzan R, Klijn AJ, et al.Treatment of the neurogenic bladder in spina bifida[J].Pediatr Nephrol, 2008, 23(6):889-896.DOI:10.1007/s00467-008-0780-7.
[3] Roth JD, Cain MP.Neuropathic bladder and augmentation cystoplasty[J].Urol Clin North Am, 2018, 45(4):571-585.DOI:10.1016/j.ucl.2018.06.005.
[4] Stein R, Bogaert G, Dogan HS, et al.EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment[J].Neurourol Urodyn, 2020, 39(1):45-57.DOI:10.1002/nau.24211.
[5] 罗德毅, 杨童欣, 林逸飞, 等.单纯肠道膀胱扩大术治疗神经源性膀胱合并输尿管反流的初步结果[J].中华泌尿外科杂志, 2015, 36(2):104-107.DOI:10.3760/cma.j.issn.1000-6702.2015.02.007. Luo YD, Yang TX, Lin YF, et al.Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux[J].Chinese Journal of Urology, 2015, 36(2):104-107.DOI:10.3760/cma.j.issn.1000-6702.2015.02.007.
[6] Snodgrass W, Villanueva C, Gargollo P, et al.New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder[J].J Pediatr Urol, 2014, 10(5):906-910.DOI:10.1016/j.jpurol.2014.02.005.
[7] Wu CQ, Franco I.Management of vesicoureteral reflux in neurogenic bladder[J].Investig Clin Urol, 2017, 58(Suppl 1):S54-S58.DOI:10.4111/icu.2017.58.S1.S54.
[8] 呼和, 蒋飞, 姬广春, 等.光修复对脊髓栓系伴神经源性膀胱大鼠的作用研究[J].临床小儿外科杂志, 2020, 19(7):648-652.DOI:10.3969/j.issn.1671-6353.2020.07.017. Hu H, Jiang F, Ji GC, et al.Effect of light repair on spinal cord tether with neurogenic bladder in rats[J].Journal of Clinical Pediatric Surgery, 2020, 19(7):648-652.DOI:10.3969/j.issn.1671-6353.2020.07.017.
[9] Xiu B, Liu FY, Shang AJ, el al.Chinese expert consensus on diagnosis and management of split cord malformation[J].Journal of Neurorestoratology, 2020, 8(2):83-92.
[10] Rendeli C, Ausili E, Tabacco F, et al.Urodynamic evaluation in children with lipomeningocele:timing for neurosurgery, spinal cord tethering and followup[J].J Urol, 2007, 177(6):2319-2324.DOI:10.1016/j.juro.2007.01.176.
[11] Tarcan T, Bauer S, Olmedo E, et al.Long-term followup of newborns with myelodysplasia and normal urodynamic findings:Is followup necessary?[J].J Urol, 2001, 165(2):564-567.DOI:10.1097/00005392-200102000-00070.
[12] Weld KJ, Graney MJ, Dmochowski RR.Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients[J].J Urol, 2000, 163(4):1228-1233.
[13] Bermingham SL, Hodgkinson S, Wright S, et al.Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters:a systematic review and cost effectiveness analysis[J].BMJ, 2013, 346:e8639.DOI:10.1136/bmj.e8639.
[14] Lamin E, Newman DK.Clean intermittent catheterization revisited[J].Int Urol Nephrol, 2016, 48(6):931-939.DOI:10.1007/s11255-016-1236-9.
[15] Leroux C, Turmel N, Chesnel C, et al.Determinants and impact of the time to perform clean intermittent self-catheterization on patient adherence and quality of life:A prospective observational study[J].Neurourol Urodyn, 2021, 40(4):1027-1034.DOI:10.1002/nau.24662.
[16] 孙宁, 张斌.小儿神经源性膀胱的诊治[J].临床小儿外科杂志, 2010, 9(1):53-55.DOI:10.3969/j.issn.1671-6353.2010.01.022. Sun N, Zhang B.Diagnosis and management of neurogenic bladder in children[J].J Clin Ped Sur, 2010, 9(1):53-55.DOI:10.3969/j.issn.1671-6353.2010.01.022.
[17] 王朝旭, 张潍平.小儿神经源性膀胱药物治疗及现状[J].中华实用儿科临床杂志, 2017, 32(23):1833-1835.DOI:10.3760/cma.j.issn.2095-428X.2017.23.022. Wang CX, Zhang WP.Trends of drug treatment for neurogenic bladder in children[J].Chinese Journal of Applied Clinical Pediatrics, 2017, 32(23):1833-1835.DOI:10.3760/cma.j.issn.2095-428X.2017.23.022.
[18] Reynolds WS, McPheeters M, Blume J, et al.Comparative effectiveness of anticholinergic therapy for overactive bladder in women:a systematic review and meta-analysis[J].Obstet Gynecol, 2015, 125(6):1423-1432.DOI:10.1097/AOG.0000000000000851.
[19] Reddy PP, Borgstein NG, Nijman RJ, et al.Long-term efficacy and safety of tolterodine in children with neurogenic detrusor overactivity[J].J Pediatr Urol, 2008, 4(6):428-433.DOI:10.1016/j.jpurol.2008.05.003.
[20] Nadeau G, Schroder A, Moore K, et al.Long-term use of solifenacin in pediatric patients with overactive bladder:Extension of a prospective open-label study[J].Can Urol Assoc J, 2014, 8(3-4):118-123.DOI:10.5489/cuaj.1356.
[21] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Group of Pediatric urology, Branch of Pediatric Surgery, Chinese Medical Association:Expert Consensus on Managing Primary Vesicoureteral Reflux in Children[J].J Clin Ped Sur, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[22] Quirino IG, Diniz JS, Bouzada MC, et al.Clinical course of 822 children with prenatally detected nephrouropathies[J].Clin J Am Soc Nephrol, 2012, 7(3):444-451.DOI:10.2215/CJN.03400411.
[23] Hajiyev P, Burgu B.Contemporary management of vesicoureteral reflux[J].Eur Urol Focus, 2017, 3(2-3):181-188.DOI:10.1016/j.euf.2017.08.012.
[24] Morioka A, Miyano T, Ando K, et al.Management of vesicoureteral reflux secondary to neurogenic bladder[J].Pediatr Surg Int, 1998, 13(8):584-586.DOI:10.1007/s003830050409.
[25] Merlini E, Beseghi U, De Castro R, et al.Treatment of vesicoureteric reflux in the neurogenic bladder[J].Br J Urol, 1993, 72(6):969-971.DOI:10.1111/j.1464-410x.1993.tb16312.x.
[26] 张帆, 廖利民, 付光, 等.肠道膀胱扩大术治疗神经源性膀胱77例疗效观察[J].中华泌尿外科杂志, 2012, 33(9):655-659.DOI:10.3760/cma.j.issn.1000-6702.2012.09.005. Zhang F, Liao LM, Fu G, et al.Augmentation enterocystoplasty on treatment of neurogenic bladder dysfunction:a single center outcomes and experience with 77 patients[J].Chin J Urol, 2012, 33(9):655-659.DOI:10.3760/cma.j.issn.1000-6702.2012.09.005.
[27] Lipski BA, Mitchell ME, Burns MW.Voiding dysfunction after bilateral extravesical ureteral reimplantation[J].J Urol, 1998, 159(3):1019-1021.
[28] Biers SM, Venn SN, Greenwell TJ.The past, present and future of augmentation cystoplasty[J].BJU Int, 2012, 109(9):1280-1293.DOI:10.1111/j.1464-410X.2011.10650.x.
[29] Hoen L, Ecclestone H, Blok BFM, et al.Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction:A systematic review[J].Neurourol Urodyn, 2017, 36(7):1685-1702.DOI:10.1002/nau.23205.
[30] Sinaiko E.Artificial bladder from segment of stomach and study of effect of urine on gastric secretion[J].Surg Gynecol Obstet, 1956, 102(4):433-438.
[31] Castellan M, Gosalbez R, Bar-Yosef Y, et al.Complications after use of gastric segments for lower urinary tract reconstruction[J].J Urol, 2012, 187(5):1823-1827.DOI:10.1016/j.juro.2011.12.105.
[32] Cheng PJ, Myers JB.Augmentation cystoplasty in the patient with neurogenic bladder[J].World J Urol, 2020, 38(12):3035-3046.DOI:10.1007/s00345-019-02919-z.
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备注/Memo
收稿日期:2021-11-16。
基金项目:浙江省科技厅公益研究计划（LGF19H090020）
通讯作者:唐达星,Email:tangdx0206@zju.edu.cn