소아 외상성 척수손상환자의 방광관리

Abstract

The importance of proper management of the neurogenic bladder has been well recognized. However, there are few reports which have further studied the methods of bladder management in children with spinal cord injuries.

The purpose of this study is to describe the types of voiding difficulty, to determine the frequencies of urinary tract complications and infections, and to establish the clinical effectiveness of bladder training in children with spinal cord injuries during their hospital stay.

Twenty six children with neurogenic bladder were trained with a timed voiding technique including stimulation, to achieve a balanced bladder.

As a result of this training, 24 of the children (92.3%) attained a balanced bladder. All 20 subjects with upper motor neuron signs revealed the hyperreflexic type of neurogenic bladder, and 4 among 6 subjects with lower motor neuron signs revealed the areflexic type. There were two cases of vesicoureteral reflux, and no subject showed abnormality in the intravenous pyelogram. Bacteriuria was documented in 20 subjects, although 17 cases were asymptomatic.

In conclusion, we propose to manage these patients with a conservative method using Credé and percussion, because it is relatively safe and useful method.