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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 姜秉鈞 | 以保守性療效治療罹患神經性排尿障礙的腦性麻痹患者之成效 | 2016/1/29 下午 04:25:29 | 0 |
| 原 文 | 題 目 | Neurogenic lower urinary tract dysfunction in adults with cerebral palsy: outcomes following a conservative management approach. |
| 作 者 | Goldfarb RA, Pisansky A, Fleck J, Hoversten P, Cotter KJ, Katorski J, Liberman D, Elliott SP | |
| 出 處 | The Journal of Urology, 2015 Oct 20 | |
| 出版日期 | Oct. 2015 | |
| 評 論 | 腦性麻痺(Cereberal palsy, CP)為在發育中的腦部造成傷害後，產生運動功能失常的現象，根據統計，小兒的腦性麻痺患者約有至少三分之一罹患神經性排尿障礙，然而成人的腦性麻痺患者，卻較少被研究，此篇文章回溯性收錄了121個成人腦性麻痺的患者，平均年齡為25歲，這些病人在成長的過程中，大多接受保守性療法，包括復健與藥物的使用為主，結果發現在其中有23%的患者罹患腎水腫(9%)，尿滯留(10%)，較嚴重的下泌尿路症狀或失禁(9%)，然而這類的患者因為運動功能有不同程度失常的關係，對於自我導尿較無法操作或進行，另外研究發現有25%的患者罹患有結石的狀況，保守性治療對於3/4的腦性麻痺的患者是有效的，但是這也告訴我們約有另外有1/4的患者可能罹患更嚴重的排尿障礙，需要泌尿科醫師更積極的檢查與治療。 | |
| abstract |
INTRODUCTION: Cerebral palsy (CP) is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction (NLUTS) is estimated to affect at least one-third of children with CP, however, there is limited data as patients transition to adulthood. We sought to describe the symptoms, sequela, and management of NLUTS in adults with CP. MATERIALS AND METHODS: We performed a retrospective chart review of adult CP patients between 2011 and 2014. Patients with prior bladder reconstruction or catheterization-based bladder drainage were excluded. Severity of CP was determined using the Gross Motor Function Classification System (GMFCS). A conservative evaluation and treatment paradigm was utilized. Non-invasive treatments were encouraged; specifically, clean intermittent catheterization (CIC), which is often not feasible, is avoided unless patients develop urinary retention, hydronephrosis, or refractory lower urinary tract symptoms (LUTS). RESULTS: There were 121 patients included in final analysis. Median age was 25 and 50% (61/121) had GMFCS level V. There were 28/121 (23%) patients who failed non-invasive management as defined by hydronephrosis (9), persistent urinary retention (10), and refractory LUTS/incontinence (9); urethral CIC was poorly tolerated. 25% of all patients had evidence of urolithiasis during study period. Surgical intervention was rare and associated with significant morbidity. CONCLUSIONS: Adults with cerebral palsy may present with variable signs and symptoms of NLUTS. Conservative management was successful in over 75% of patients. CIC was poorly tolerated in patients who failed conservative treatment. Surgical intervention was rarely indication and should be reserved for individuals. |
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