Urodynamic Study of Neurogenic Voiding Dysfunction in Children

为探讨全身麻醉（GA）下尿动力学研究的可行性，我们对73例小儿进行了尿道外括约肌肌电图（EUS-EMG）检查。膀胱尿道镜检查后，在轻度麻醉下进行EUS-EMG检查结构异常。在83%的患者中观察到排尿。在排尿的患者中，分别在7例（38%）I组患者和6例（19%）II组患者中观察到逼尿肌-外括约肌协同失调（DSD）-有和无明显的神经脊髓缺损。对55例（2个月~ 14岁，平均4.5岁）泌尿系疾病患儿进行了VCU与EUS-EMG诊断的DSD的对比分析。所有患儿至少有1项检查结果提示功能障碍：1）无用力排尿和/或排尿困难，2）残余尿率大于20%，3）膀胱移行细胞癌。 关于我们 4）VCU显示后尿道或中尿道扩张，计算每例患儿后尿道或中尿道最大径（PUD）及VCU显示EUS的最大径（EUSD），将PUD除以EUSD大于2定义为显著性尿道扩张（UD）。21名儿童（38%）记录了DSD。9例无力排尿和间歇性排尿患儿均出现DSD（9/9，100%），16例无力排尿和间歇性排尿患儿中9例（56%）出现DSD。相比之下，只有3例（10%）正常血流的儿童记录到了DSD。DSD组尿沉渣阳性率、尿道扩张率和膀胱小梁形成率分别为71%和32%（P &lt; 0.01）<0.005>，93%和64%（P <0.005>&lt; 0.01），71%和35%（P <0.001>&lt; 0.01）。VSD患儿VCU上EUSD较非VSD患儿明显降低（平均2.0mm vs4.6mm，P&lt;0.00001）。以EUSD 3 mm为界值，敏感性、特异性、阳性预测值和阴性预测值分别为93%、86%、78%和96%。VCU上EUSD对儿童DSD的诊断准确率较高。少

To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS-EMG) on 73 children. EUS-EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Voiding was observed in 83% of the patients. Among patients who voided, detrusor-external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients -with and without overt neurospinal defect, respectively. In children with urinary disorders, urodynamic study under GA is a feasible method for assessing EUS function and documenting DSD.VCU findings were comparatively analyzed with DSD defined with external urethral sphincer electromyography (EUS-EMG) in 55 children (from 2 months to 14 years with a mean of 4.5 years). All children had at least I finding indicating dysfunction : 1) forceless voiding and/or intermittency, 2) rate of residual urine of greater than 20% 3 bladder tra … More beculation on cystography, 4) dilatation of posterior urethra (boys) or mid-urethra (girls) on VCU.We calculated the maximal diameter of posterior urethra or mid-urethra and (PUD) the diameter of EUS (EUSD) on VCU in each children, and defined PUD divided by EUSD greater than 2 as significant urethral dilatation (UD). DSD was documented in 21 children (38%). All children with both forceless voiding and i termittency had DSD (9/9,100%), while DSD was observed om 9 of 16 (56%) children with either of them. In contrast DSD was documented only in 3 (10%) in children with normal flow. Positive rate of residuals, urethral dilatation (UD) nad bladder trabeculation were demonstrated more frequently in children with DSD than those without DSD : 71% vs 32% (P<0.005>, 93% vs 64% (P<0.005>, 71% vs 35% (P<0.001>, respectively. EUSD on VCU was significantly decreased in children with DSD compared to those without DSD(a mean of 2.0mm va 4.6mm, P<0.00001). When we defined 3mm of EUSD as the cut-off value, sensitivity, specificity positive and negative predictive value were 93%, 86% 78% and 96% respectively. DSD could be diagnosed with satisfactory accuracy by EUSD on VCU in children. Less