儿童功能性膀胱括约肌疾病的临床、尿动力学和进化特征

Maryem Ferjani, Yousra Hammi, Taha Sayari, Rym Baati, Naija Ouns, Tahar Gargah
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引用次数: 0

摘要

背景:儿童膀胱括约肌疾病是导致功能和心理残疾的原因。他们还负责类似于神经膀胱并发症的严重的肾功能并发症。在这项研究中,我们寻找与这些疾病相关的临床表现,以及临床旁和尿动力学异常及其治疗方法。方法:我们对突尼斯Charles Nicolle医院儿科的膀胱括约肌疾病患者进行了回顾性和描述性研究。结果:本研究共纳入26例患者。儿童肾脏科首次会诊时的中位年龄为9岁(IQR 25=6岁;IQR 75=11岁)。女孩占多数:19名男孩和43名女孩。充盈期和排尿期以三种或三种以上症状的组合为主。膀胱压痛减少了12%。19%的患者报告在排尿后阶段出现排尿后运球。36%的病例的流速曲线是多相的,11%的病例的流量曲线是平坦的。空隙后残留物的中位数为62.2 mL(IQR 25=25 mL;IQR 75=102 mL)。膀胱测量术显示14%的病例膀胱感觉减轻,65%的病例逼尿肌过度活动,8%的病例膀胱收缩力低下,42%的病例膀胱顺应性低下,88%的病例膀胱容量小。34%的患者出现括约肌功能障碍。抗胆碱能药物是治疗疾病最多的药物(53%)。45%的患者出现肾功能衰竭,其中11%的患者出现终末期肾功能衰竭。在随访期间,16%的患者需要肾脏替代治疗。结论:鉴于儿童膀胱括约肌疾病的严重性,以及大多数病例在并发症阶段发现较晚,必须在初级保健医生的持续培训基础上进行有针对性的初级预防,以尽量减少涉及这些儿童功能和生命预后的并发症的出现。
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[Functional vesico-sphincteric disorders in children: clinical, urodynamic and evolutionary profile].

Background: Childhood vesico-sphincteric disorders are the cause of functional and psychological disability. They are also responsible for serious uronephrologic complications akin to neuro-bladder complications. In this study, we looked for the clinical manifestations linked to these disorders as well as the paraclinical and urodynamic anomalies and their therapeutic management.

Methods: We carried out a retrospective and descriptive study of patients with vesico-sphincteric disorders, followed in the pediatrics department of Charles Nicolle hospital in Tunis.

Results: In total 26 patients were included in our study. The median age at the first consultation in a pediatric nephrology department was 9 years (IQR 25 = 6 years; IQR 75 = 11 years). There was a predominance of girls: 19 boys and 43 girls. The filling phase and the voiding phase were dominated by the combination of three or more symptoms. Bladder tenderness was reduced in 12% of cases. Nineteen percent of patients reported post micturition dribble in the post-voiding phase. The flow rate curve was polyphasic in 36% of cases and flat in 11% of cases. The median of the post void residual was 62, 2 mL (IQR 25 = 25 mL; IQR 75 = 102 mL). Cystometry showed reduced bladder sensation in 14% of cases, detrusor overactivity in 65% of cases, bladder hypocontractility in 8% of cases, hypocompliant bladder in 42% of cases and small capacity in 88% of cases. Sphincter dysynergia was noted in 34% of patients. Anticholinergics were the most used in the treatment of disorders (53%). Renal failure was noted in 45% of the patients of which 11% had end-renal stage failure. During follow-up 16% of our patients required kidney replacement therapy.

Conclusion: Given the seriousness of vesico-sphincteric disorders in children and the late discovery in the majority of cases at the complication stage, targeted primary prevention must be carried out based on continuous training of primary care physicians to minimize the appearance of complications involving the functional and vital prognosis of these children.

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