KẾT QUẢ THÔNG TIỂU NGẮT QUÃNG SẠCH ĐIỀU TRỊ BỆNH NHÂN BÀNG QUANG THẦN KINH DO DỊ TẬT NỨT ĐỐT SỐNG BẨM SINH

Abstract

Aim: Describe the results of clean intermittent catheterization in patients with neurogenic bladder after surgery for congenital spina bifida. Subject: Descriptive study evaluates before and after clean intermittent catheterization in neurogenic bladder patients after surgery for spina bifida at the National Children's Hospital from March 1 2013 to March 31, 2019. Ultrasound describes the condition of the renal pelvic-ureteral dilation, voiding cystography describes vesicoureteral reflux and cystometry describes the parameters. Variables were assessed before and after clean intermittent catheterization. Statistical test mcnemar evaluates the effectiveness of pyelonephritis - ureteral dilatation and vesicoureteral reflux with p < 0.05 with statistical significance. Results: There were 62 neurogenic bladder patients after surgery for spina bifida, with 27 males accounting for 43.5%, and 35 females accounting for 56.5%. Myelomeningocele accounted for the majority with a rate of 72.6%, and lipomyelomyelomeningocele was 27.4%. The location of the below 4th spinal cord lesion was 40.3% and the sacral spinal cord lesion was 50.9%. Urinary incontinence is 100% of cases. The improvement of pelvic-ureteral dilation before and after clean intermittent catheterization was not statistically significant in 32.3% compared with 25.8%. Similarly, the improvement of vesicoureteral reflux before and after clean intermittent catheterization was not statistically significant at 46.8% versus 35.5%. For cases with vesical pressure < 30 cmH2O after clean intermittent catheterization, the bladder capacity before and after clean intermittent catheterization is normal (> 80%), in contrast to cases with vesical pressure > 30 cmH2O after CIC, bladder capacity is smaller for age (< 65%). The age at initiation of clean intermittent catheterization was 3.2 ± 2.8 years (0.3 - 11.5 years), with a median follow-up is 39.9 ± 15.1 months (24 - 65 months). There are 51.6% of patients with urinary continence after clean intermittent catheterization. Conclusions: Clean intermittent catheterization helps to improve 50% of patients with urinary incontinence and maintain bladder capacity, and vesical pressure in cases where the bladder capacity for age is > 80% before, vesical pressure < 20 cmH2O. However, clean intermittent catheterization improved renal pelvic-ureteral dilation and vesicoureteral reflux was not statistically significant