Videourodynamic findings in young infants with severe primary reflux.
Videourodynamic findings in young infants with severe primary reflux.
复制标题
患有严重原发性反流的小婴儿的视频尿动力学发现。
DOI：
10.1097/01.ju.0000108126.23417.17
复制
发表时间：
2004
影响因子：
6.6
通讯作者：
A. Ruarte
中科院分区：
文献类型：
--
作者：
M. Podestá;R. Castera;A. Ruarte
目的
我们通过视频尿动力学研究了重度原发性膀胱输尿管反流（VUR）婴儿的膀胱功能，并分析了排尿周期中VUR与膀胱逼尿肌内压的关系。
材料和方法
从1999年至2001年，3名女性和9名男性婴儿，中位年龄为9个月的VUR进行了传统的填充视频尿动力学在我们的机构。4例经产前检测确诊，8例经症状性尿路感染后确诊。5例为双侧返流，7例为单侧返流（分别为7例、7例和3例III至V级）。对照组包括10名年龄匹配的婴儿（中位年龄4个月），采用相同的尿动力学方法进行研究。
结果
预期年龄+/- SD的中位膀胱测压膀胱容量为50% +/- 58%（范围20%-240%）。10例患者膀胱容量低（小于80%）。仅1例患者在充盈期出现逼尿肌过度活动。除1例病例外，所有病例的排尿均与高逼尿肌压力峰值（中位数87 +/- 25 cm水柱）交替，与间歇性外括约肌收缩和正常协调排尿（中位数36 +/- 7 cm水柱）相关。膀胱残余尿（30%或以上）3例。5例VUR发生在膀胱压力增加时，7例发生在稳定充盈时。反流患者和对照组之间无显著膀胱测压差异。
结论
大多数VUR患儿在充盈期膀胱容量下降，逼尿肌活动正常。高排尿压力伴括约肌过度活动与正常排尿并存。这种排尿模式可能代表了正常尿液控制的一个发育阶段，它可能在某些婴儿反流的病因学中起作用。
PURPOSE
We investigated bladder function on videourodynamic studies in infants with severe primary vesicoureteral reflux (VUR) and analyzed the relationship between VUR and intravesical detrusor pressure during the micturition cycle.
MATERIALS AND METHODS
From 1999 to 2001, 3 female and 9 male infants with a median age of 9 months with VUR underwent conventional filling videourodynamics at our institution. Four cases were diagnosed by prenatal detection and 8 were diagnosed after symptomatic urinary tract infections. Reflux was bilateral in 5 cases and unilateral in 7 (grades III to V in 7, 7 and 3, respectively). Controls included 10 age matched infants (median age 4 months) studied with the same urodynamic methodology.
RESULTS
Median cystometric bladder capacity expected for age +/- SD was 50% +/- 58% (range 20% to 240%). Bladder capacity was low (less than 80%) in 10 patients. Detrusor overactivity during filling was found in only 1 patient. In all except 1 case voiding alternated with peaks of high detrusor pressure (median 87 +/- 25 cm water), associated with intermittent external sphincter contractions with normal coordinated micturition (median 36 +/- 7 cm water). Cystometric residual urine (30% or greater) was noted in 3 cases. In 5 patients VUR occurred with an increase in bladder pressure, while in 7 it occurred during stable filling. No significant cystometric differences were found between patients with reflux and controls.
CONCLUSIONS
Most infants with VUR had decreased cystometric bladder capacity and normal detrusor activity during filling. High voiding pressure with concomitant sphincteric overactivity coexisted with normal micturition. This voiding pattern might represent a developmental stage of normal urine control and it may have a role in the etiology of reflux in some infants.