Abstract：
To review the urological outcomes of proactive versus delayed management of children with a neurogenic bladder (NB).
We performed a literature search on EMBASE, MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials between January 1, 2000 to August 21, 2023 for studies investigating the management of spina bifida-associated NB in pediatric patients (0-18 years of age). Proactive management was defined as use of clean intermittent catheterization, and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings by 1 year of age. Delayed management was defined as beginning management after 1 year of age or no intervention. Outcomes included incidence or diagnosis of secondary vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal deterioration, which included renal scarring, loss of differential renal function on a nuclear scan, or a decrease in renal function defined by glomerular filtration rate or serum creatinine estimation. Forest plots were synthesized using the Inverse Variance method with random-effect model. The Risk of Bias was assessed using the ROBINS-I tool.
We included 8 observational studies on 652 pediatric patients with spina bifida-associated NB (mean follow-up - 7 years). Proactive management following initial assessment was associated with significantly lower risks of secondary VUR (OR 0.37 [0.19, 0.74], p = 0.004), non-febrile UTI (OR 0.35 [0.19, 0.62], p = 0.0004), and renal deterioration (OR 0.31 [0.20, 0.47], p < 0.00001).
Delayed management of NB potentially has 3 times higher risks of secondary VUR, non-febrile UTI, and renal deterioration. However, the evidence is limited by the high risk of bias due to lack of randomization and standardized reporting in observational studies.
While further well-defined prospective studies with long-term follow-up should be conducted to confirm this finding, this study supports the EAU/ESPU recommendations for early intervention in children with NB.
We performed a literature search on EMBASE, MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials between January 1, 2000 to August 21, 2023 for studies investigating the management of spina bifida-associated NB in pediatric patients (0-18 years of age). Proactive management was defined as use of clean intermittent catheterization, and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings by 1 year of age. Delayed management was defined as beginning management after 1 year of age or no intervention. Outcomes included incidence or diagnosis of secondary vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal deterioration, which included renal scarring, loss of differential renal function on a nuclear scan, or a decrease in renal function defined by glomerular filtration rate or serum creatinine estimation. Forest plots were synthesized using the Inverse Variance method with random-effect model. The Risk of Bias was assessed using the ROBINS-I tool.
We included 8 observational studies on 652 pediatric patients with spina bifida-associated NB (mean follow-up - 7 years). Proactive management following initial assessment was associated with significantly lower risks of secondary VUR (OR 0.37 [0.19, 0.74], p = 0.004), non-febrile UTI (OR 0.35 [0.19, 0.62], p = 0.0004), and renal deterioration (OR 0.31 [0.20, 0.47], p < 0.00001).
Delayed management of NB potentially has 3 times higher risks of secondary VUR, non-febrile UTI, and renal deterioration. However, the evidence is limited by the high risk of bias due to lack of randomization and standardized reporting in observational studies.
While further well-defined prospective studies with long-term follow-up should be conducted to confirm this finding, this study supports the EAU/ESPU recommendations for early intervention in children with NB.
摘要：
目的：回顾神经源性膀胱（NB）患儿的泌尿外科结果。
方法：我们在EMBASE上进行了文献检索，MEDLINE,Scopus,WebofScience,以及2000年1月1日至2023年8月21日期间的Cochrane中央对照试验注册，用于调查儿科患者（0-18岁）脊柱裂相关NB的管理。前瞻性管理定义为使用清洁间歇性导管插入术，和/或抗胆碱能药物，或基于1岁时最初的高危尿动力学检查结果。延迟管理定义为在1岁或无干预后开始管理。结果包括继发性膀胱输尿管反流（VUR）的发生率或诊断，尿路感染（UTI），和肾脏恶化，其中包括肾脏疤痕，在核扫描中肾功能的差异丧失，或由肾小球滤过率或血清肌酐估计定义的肾功能下降。使用具有随机效应模型的逆方差方法合成了森林地块。使用ROBINS-I工具评估偏差风险。
结果：我们纳入了8项观察性研究，纳入了652例脊柱裂相关NB患儿（平均随访-7年）。初始评估后的主动管理与继发性VUR的风险显着降低相关（OR0.37[0.19,0.74]，p=0.004),非发热UTI（OR0.35[0.19，0.62]，p=0.0004),和肾脏恶化（OR0.31[0.20，0.47]，p<0.00001)。
结论：NB的延迟管理可能会使继发性VUR的风险高出3倍，非发热UTI,和肾脏恶化。然而,由于观察性研究中缺乏随机化和标准化报告,偏倚风险较高,因此证据有限.
结论：虽然应进行进一步明确的长期随访前瞻性研究以证实这一发现，本研究支持EAU/ESPU对NB患儿早期干预的建议.
方法：我们在EMBASE上进行了文献检索，MEDLINE,Scopus,WebofScience,以及2000年1月1日至2023年8月21日期间的Cochrane中央对照试验注册，用于调查儿科患者（0-18岁）脊柱裂相关NB的管理。前瞻性管理定义为使用清洁间歇性导管插入术，和/或抗胆碱能药物，或基于1岁时最初的高危尿动力学检查结果。延迟管理定义为在1岁或无干预后开始管理。结果包括继发性膀胱输尿管反流（VUR）的发生率或诊断，尿路感染（UTI），和肾脏恶化，其中包括肾脏疤痕，在核扫描中肾功能的差异丧失，或由肾小球滤过率或血清肌酐估计定义的肾功能下降。使用具有随机效应模型的逆方差方法合成了森林地块。使用ROBINS-I工具评估偏差风险。
结果：我们纳入了8项观察性研究，纳入了652例脊柱裂相关NB患儿（平均随访-7年）。初始评估后的主动管理与继发性VUR的风险显着降低相关（OR0.37[0.19,0.74]，p=0.004),非发热UTI（OR0.35[0.19，0.62]，p=0.0004),和肾脏恶化（OR0.31[0.20，0.47]，p<0.00001)。
结论：NB的延迟管理可能会使继发性VUR的风险高出3倍，非发热UTI,和肾脏恶化。然而,由于观察性研究中缺乏随机化和标准化报告,偏倚风险较高,因此证据有限.
结论：虽然应进行进一步明确的长期随访前瞻性研究以证实这一发现，本研究支持EAU/ESPU对NB患儿早期干预的建议.
