神經性膀胱患者夜間導尿治療的臨床成果

鐘伯恩¹、王士綱¹、、楊緒棣^1,2

佛教慈濟醫療財團法人台北慈濟醫院 泌尿科; 慈濟大學 醫學系

Clinical Results of Overnight Catheterization in Patients with Neurogenic Bladder

Bor-En Jong¹, Shih-Gang Wang¹, Shei-Dei Yang^1,2

Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

Purpose:

To report our experience in overnight catheter drainage (OCD) which has been reported as a useful tool among children to reduce the frequency of UTIs, and improve upper tract dilatation and continence.

Materials and Methods:

During 2018 to 2021, we recruited 9 patients (6 children and 3 adults, aged from 3 years old to 71 years old) with neuropathic bladder. Their clinical manifestations included impaired renal function, recurrent urinary tract infection (UTI), hydronephrosis, vesicoureteral reflux (VUR) and interrupted sleeping. Serum creatinine level and kidney ultrasonography were compared before and after OCD. Grade of VUR was evaluated with video urodynamic study (VUDS).

Results:

The reasons for receiving OCD were recurrent urinary tract infection (N = 5), renal function impairment (N = 4), VUR (N = 5), small bladder capacity (N = 1), and hydronephrosis (N = 1). The underlying diseases were  spinal bifida, adrenogenital disorder, neurogenic bladder and genitourinary tract malignancy. Treatment strategies before OCD were clean intermittent catheterization (CIC, N = 9) and botulinum toxin injection (N = 6). Among the 5 patients with recurrent UTI, all had improvement not only in the frequency but also in the severity of UTI. Serum creatinine levels were lowered from 2.11 mg/dL +/- 0.43 mg/dL before OCD to 1.63 mg/dL +/- 0.24 mg/dL in the renal function impairment group. In the VUR group, 2 patients achieved complete remission of VUR on VUDS after OCD, and the other 3 patients had a significantly larger infused volume at presentation of VUR on post-OCD VUDS.

Conclusion:

Overnight catheterization drainage with daytime clean intermittent catheterization may be an eligible tool to improve renal compromise, recurrent UTI and reduce VUR in the selective patients with neuropathic bladder.