After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update.
In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option.
In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.
经过涵盖2000-2017年期间的系统文献回顾,ESPU/EUAU神经源性膀胱指南进行了更新。
在这些患者中,手术干预措施,如肉毒杆菌毒素A注射到逼尿肌,膀胱扩大术,甚至尿流改道可能成为必要,以保持上(和下)尿路的功能。应向难以进行经尿道清洁间歇性导管插入的患者提供大陆可导管通道的创建。然而,需要考虑高达50%的修订率。随着年龄的增长,尿液和粪便的节制变得越来越重要。在持续存在弱膀胱出口的患者中,只有通过在膀胱出口水平上产生更高的阻力/阻塞的手术干预才能实现完全的尿失禁,成功率高达80%。在一些患者中,膀胱颈闭合和创建大陆可导管造口是一种选择。
在所有这些患者中,必须进行密切随访以及早发现手术并发症和代谢后果。