이분척추 환아에서 방광 내 전기자극치료

Abstract

PURPOSE: Intravesical electrical stimulation (IVES) has been performed for various PURPOSEs in children with voiding difficulty due to neurogenic or non-neurogenic causes. The effect of IVES in children with spina bifida, however, remains controversial. The aim of this study is to investigate the effect of IVES according to the type of neurogenic bladder in children with spina bifida. MATERIALS AND METHODS: Among the 74 patients who received IVES at Severance Hospital between May, 1999 and October, 2001, 40 children with available comparative urodynamic data before and after treatment were retrospectively analyzed. According to pre-IVES urodynamic study, children were divided into 4 groups: areflexic-compliant (Group I), areflexic-poorly compliant (Group II), hyperreflexic-compliant (Group III) and hyperreflexic-poorly compliant (Group IV). We investigated the changes in uninhibited bladder contraction, bladder filling sense, defecation sense, urinary incontinence and fecal incontinence. In the 33 children under the age of 9 years, changes of age- adjusted bladder capacity were compared by the formula of Palmer et al. RESULTS: The age-adjusted bladder capacity was significantly increased from 1.0016+/-0.3811 to 1.1982 / 0.3945 (p=0.0002), 1.0107 / 0.4484 to 1.0522 / 0.4479 (p=0.1595), 1.0371 / 0.2979 to 1.2410 / 0.4490 (p=0.1669), and 0.8366 / 0.1401 to 0.9449 / 0.1129 (p= 0.0162) in groups I to IV, respectively. Self-voiding was increased from 18.8% to 50.0% only in Group I. Uninhibited bladder contraction was decreased from 100% to 40.0%, and from 100% to 25.0% in Groups III and IV, respectively. There were improvements in bladder filling sense, defecation sense, urinary incontinence and fecal incontinence in all groups. CONCLUSIONS: Age-adjusted bladder capacity was significantly increased after IVES in children with spina bifida. There was a significant increase in self-voiding ability only in the areflexic-compliant group, suggesting that IVES can be particularly more effective in this specific group of spina bifida children.