Urodynamic Study of Neurogenic Voiding Dysfunction in Children

为探讨全身麻醉(GA)下尿流动力学检查的可行性，我们对73例患儿进行了尿路外括约肌肌电检查。EUS-EMG在膀胱镜检查后的轻度麻醉下进行，以检查结构异常。83%的患者有排尿现象。在排尿的患者中，有7例(38%)I组患者和6例(19%)II组患者出现逼尿肌-外括约肌协同失调(DSD)，分别伴有和不伴有明显的神经脊髓缺陷。对55例2个月~14岁，平均4.5岁的儿童，在GA下进行尿流动力学检查，是评估EUS功能和记录DSD的一种可行的方法。所有儿童至少有以下症状：1)无用力排尿和/或间歇性排尿；2)残余尿率大于20%；3)膀胱…4)后尿路扩张(男)或中尿路扩张(女)。计算后尿路或中尿路最大径(PUD)和VCU上EUS直径(EUD)，并将PUD除以EUS>2为显著尿路扩张(UD)。有21名儿童(38%)记录有DSD。所有同时有无强迫排尿和间歇性排尿的儿童都有DSD(9/9,100%)，而其中有一者的DSD有9例(56%)。相比之下，在血流正常的儿童中，只有3例(10%)记录到DSD。残留尿路扩张(UD)和膀胱小梁的发生率在DSD组明显高于非DSD组：71%比32%(P&lt；0.005；，93%比%(P&lt；0.005；，71%比35%(P&lt；0.001&>t；)。患有DSD的儿童VCU上的EU.S.显著低于无DSD的儿童(平均值为2.0 mm和4.6 mm，P&lt；0.00001)。以EUD3 mm为临界值，其敏感性、特异性、阳性预测值和阴性预测值分别为93%、86%、78%和96%。超声心动图对儿童DSD的诊断准确率令人满意。较少

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