清洁间歇导尿联合托特罗定治疗瓣膜膀胱综合征的疗效分析

Analysis of the Efficacy of Clean Intermittent Catheterization Combined with Tolterodine in the Treatment of Valvular Bladder Syndrome

摘要: 目的：探讨早期清洁间歇导尿(Clean intermittent catheterization, CIC)联合托特罗定治疗膀胱瓣膜综合征的疗效，为后尿道瓣膜术后改善膀胱功能提供参考。方法：回顾性分析我中心行膀胱镜后尿道瓣膜切除术后患儿36例。术后首次随访尿动力学提示小膀胱容量或/和膀胱顺应性差或/和逼尿肌不稳定和/或诊断为膀胱过度活动，并且有残余尿。按照既往治疗方式分为CIC联合托特罗定组(n = 20)和CIC组(n = 16)。在治疗后1个月随访两组尿动力检查、尿路造影。结果：治疗后1月，尿动力学中，CIC联合托特罗定组逼尿肌不稳定率及膀胱顺应性差发生率低于CIC组(p < 0.05)，CIC联合托特罗定组的膀胱最大容量、最大逼尿肌压力结果优于CIC组(p < 0.05)。尿路造影中，CIC联合托特罗定组的肾积水率与CIC组无明显差异(p > 0.05)。结论：CIC联合托特罗定对后尿道瓣膜切除术后患儿可改善膀胱功能，短期效果明显。

Abstract: Objective: To investigate the efficacy of early clean intermittent catheterization (CIC) combined with tolterodine in the treatment of bladder valve syndrome and to provide a reference for improving bladder function after posterior urethral valvulotomy. Methods: A retrospective analysis of 36 children who underwent cystoscopic posterior urethral valve resection at our centre. The first postoperative follow-up urodynamics suggested overactive bladder and/or small bladder capacity or/and poor bladder compliance or/and instability of the detrusor muscle, and residual urine. The CIC combined with tolterodine group (n = 20) and the CIC group (n = 16) were divided according to previous treatment. Both groups were followed up at 1 month after treatment with urodynamic tests and urography. Results: 1 month post-treatment, in urodynamics, the rates of forceps instability and poor bladder compliance were lower in the CIC combined with tolterodine group than in the CIC group (p < 0.05), and the results of maximal bladder volume, maximal forceps pressure were better in the CIC combined with tolterodine group than in the CIC group (p < 0.05). In urography, the rate of hydronephrosis in the CIC combined with tolterodine group was not significantly different from that in the CIC group (p > 0.05). Conclusion: CIC combined with tolterodine improves bladder function in children after posterior urethral valvulotomy with significant short-term results.