소아 신경인성방광에서의 간헐적 도뇨와 항콜린성 약물치료의 효과
The Effects of Intermittent Catheterization and Anticholinergc Drug in the Treatment of Children with Neurogenic Bladder
강진화, 곽철, 김광명, 최황,
소속 상세정보
강진화 ( )
서울대학교
곽철 ( )
서울대학교
김광명 ( )
서울대학교
최황 ( )
서울대학교
KMID : 0358319930340030512
Abstract
From 1985 to 1991, we analyzed experiences in the treatment of 37 children with neurogenic bladder who were closely followed up for averaging 25 months. Initial urodynamic study revealed hyperreflexic bladder in 17 patients: 12 with detrusor
sphincter
dyssynergia. Areflexic bladder was found in 20 patients: 11 with high leak pressure. Among the 17 patients with hyperreflexic bladder, intermittent catheterization had been well performed in 13 patients and in 11 cases of which oral or topical
anticholinergics were added. Renal function was well preserved and urinary incontinence was improved in 10 of 13 patients and urinary diversion was done in 1 case. In 4 patients that were not treated by intermittent catheterization owing to poor
compliances augmentation cystoplasty was performed or to be considered. Four cases of areflexic bladder with high leak pressure had good results with treatment, whereas 4 cases had deterioration of renal function pecause of poor compliance to
treatment.
Among 9 cases of areflexic bladder with low leak pressure, 6 cases were treated by intermittent catheterization. In all of which voiding symptoms were improved. The other 3 cases are under observation without any problems except urinary
incontinence.
As above, we can conclude that preservation of renal function and improvement of urinary incontinence can be achieved with intermittent catheterization and oral or topical anticholinergics in pediatric neurogenic bladder patients and that
noninvasive
treatment including Crede maneuver may be used in the treatment of patients with areflexic pladder with low leak pressure.
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