Abstract:
OBJECTIVES:To assess whether conservative treatment of pediatric patients with neurogenic detrusor overactivity (NDO) results in lower bladder pressure and increased expected bladder volume (EBV), we investigated the clinical and urodynamic effects of long-term intravesical oxybutynin instillation compared with a standard treatment of oral anticholinergic medication in patients with clean intermittent catheterization (CIC). METHODS:A retrospective study was performed including 21 patients suffering from myelomeningocele and NDO. Initially, all patients were treated with oral anticholinergics and CIC. Ten of the 21 patients showed a sufficient response to the treatment and were included in group I (anticholinergics and CIC). The other 11 patients responded poorly to the initial treatment or developed side effects to oral medication. These patients were included in group II and treated with intravesical oxybutynin and CIC. The two groups were compared using clinical, sonographic and urodynamic examinations performed prior to starting treatment and repeated on an annual basis. Changes from baseline were analyzed with the Mann-Whitney U test. RESULTS:Ten patients in group I and 11 in group II were investigated. Two of the 11 patients in group II stopped the treatment. The mean starting age was 8.1 (± 6.6) years in group I and 12.5 (± 4.5) years in group II. The mean follow-up time was 7.1 (± 5.5) years in group I and 3.6 (± 1.8) years in group II. Bladder capacity increased from 173 (± 99) to 371 (± 115) ml in group I and from 245 (± 133) to 370 (± 156) ml in group II. Six of the 10 patients in group I and 6/9 patients in group II reached normal EBV. Three of the 10 subjects in group I and 6/9 in group II had bladder compliance values >10 ml/cm H(2)O. At final follow-up, the overall rate of urinary tract infections was equal. Social continence was achieved in 6/10 in group I and 7/9 in group II. Altogether, 19/21 patients responded to conservative management. CONCLUSIONS:In children with NDO, conservative medical treatment combined with CIC is feasible and provides an improved pattern of bladder function, which could help avoid bladder surgery.
journal_name
Int Urol Nephroljournal_title
International urology and nephrologyauthors
Lehnert T,Weisser M,Till H,Rolle Udoi
10.1007/s11255-011-0030-ysubject
Has Abstractpub_date
2012-04-01 00:00:00pages
335-41issue
2eissn
0301-1623issn
1573-2584journal_volume
44pub_type
杂志文章abstract::Disorders in calcium, phosphorus, and parathyroid hormone (PTH) are common in chronic kidney disease (CKD) and may be associated with poor outcomes including a higher rate of CKD progression and increased death risk. Although these abnormalities have been examined extensively in patients with CKD stage 5 who are recei...
journal_title:International urology and nephrology
pub_type: 杂志文章,评审
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journal_title:International urology and nephrology
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journal_title:International urology and nephrology
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