Urodynamic Study of Neurogenic Voiding Dysfunction in Children

为了评估全麻（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）检查。膀胱输尿管镜检查后在轻麻醉下进行EUS-EMG检查结构异常。83%的患者出现排尿。在排尿的患者中，分别有7例（38%）I组患者和6例（19%）II组患者出现逼尿肌-外括约肌协同障碍（DSD），并伴有或不伴有明显的神经脊柱缺损。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。将55例儿童（2个月~ 14岁，平均4.5岁）的VCU表现与外尿道括约肌肌电图（EUS-EMG）定义的DSD进行比较分析。所有患儿均至少有1项功能障碍：1)排尿无力和/或间歇性排尿，2)残尿率大于20%，3)膀胱瘘，4)VCU检查后尿道扩张（男孩）或中尿道扩张（女孩）。计算每个患儿后尿道或中尿道最大直径（PUD）及VCU上EUS直径（EUSD），将PUD除以大于2的EUSD定义为明显尿道扩张（UD）。21名儿童（38%）被记录为DSD。所有无强迫排尿和间歇性排尿的儿童都有DSD(9/ 9100%)，而16名无强迫排尿和间歇性排尿的儿童中有9名（56%）出现DSD。相比之下，在血流正常的儿童中，只有3例（10%）记录了DSD。DSD患儿残差、尿道扩张和膀胱小梁的阳性率分别为71%比32% （P<0.005>）、93%比64% （P<0.005>）、71%比35% （P<0.001>）。DSD患儿与无DSD患儿相比，VCU上的EUSD显著降低（平均2.0mm vs 4.6mm， P<0.00001）。以3mm的EUSD为临界值，敏感性为93%，特异性为86%，阳性预测值为78%，阴性预测值为96%。儿童VCU上的EUSD诊断DSD具有满意的准确性。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