Urodynamic Study of Neurogenic Voiding Dysfunction in Children

儿童神经源性排尿障碍的尿动力学研究

• 批准号: 08457418
• 负责人: KOYANAGI Tomohiko
• 金额: $ 4.86万
• 依托单位: Hokkaido University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08457418/
• 关键词: Neurogenic Voiding Dysfunction; Anesthesia; Urodynamics; Sphincter EMG; Bladder Pressure; Detrusor Sphincter Dyssynergia; Bladder Compliance; Voiding Cystourethrography; 排尿時膀胱尿道造影; 後部尿道最大径; 外尿道括約筋部最大径

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

为了评估全身麻醉 (GA) 下尿动力学研究的可行性，我们对 73 名儿童进行了尿道外括约肌肌电图 (EUS-EMG)。膀胱尿道镜检查后在浅麻醉下进行 EUS-EMG，以检查结构异常。 83% 的患者观察到排尿。在排尿的患者中，分别有 7 名 (38%) 组 I 患者和 6 名 (19%) 组 II 患者出现逼尿肌-外括约肌协同失调 (DSD)，有或没有明显的神经脊髓缺陷。对于患有泌尿系统疾病的儿童，GA下的尿动力学研究是评估EUS功能和记录DSD的可行方法。对55名儿童（2个月至14岁，平均4.5岁）的VCU结果与尿道外括约肌肌电图（EUS-EMG）定义的DSD进行了比较分析。所有儿童至少有 I 发现表明功能障碍：1) 无力排尿和/或间歇性，2) 残余尿率大于 20% 3 膀胱造影显示膀胱内射精，4) VCU 上后尿道（男孩）或中尿道（女孩）扩张。我们计算了后尿道或中尿道的最大直径和（PUD） 每个儿童的 VCU 上的 EUS (EUSD) 直径，并将 PUD 除以 EUSD 大于 2 定义为显着尿道扩张 (UD)。 21 名儿童 (38%) 被记录为 DSD。所有同时患有无用力排尿和间歇性排尿的儿童均患有 DSD (9/9,100%)，而 16 名患有其中任何一种的儿童中有 9 名 (56%) 观察到 DSD。相比之下，只有 3 名（10%）血流正常的儿童出现 DSD。与无 DSD 的儿童相比，有 DSD 的儿童更频繁地表现出残渣、尿道扩张 (UD) 和膀胱小梁的阳性率：分别为 71% vs 32% (P<0.005>、93% vs 64% (P<0.005>、71% vs 35% (P<0.001>)。与没有 DSD 的儿童相比，有 DSD 的儿童 VCU 上的 EUSD 显着降低 DSD（平均值为 2.0mm va 4.6mm，P<0.00001）。当我们定义 3mm 的 EUSD 为截止值时，敏感性、特异性阳性和阴性预测值分别为 93%、86%、78% 和 96%。 EUSD 对 VCU 儿童 DSD 的诊断准确率令人满意。少

项目成果

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