原发性夜遗尿症尿动力学检查评估

Urodynamic evaluation of 156 children with primary nocturnal enuresis

目的探讨原发性夜遗尿(PNE)儿童的尿动力学表现形式并评估其价值。方法156例PNE患儿分单症状性遗尿(MPE)(120例)和复杂性遗尿(CPE)(36例)二组。因上尿路疾病需要手术治疗而下尿路功能正常的20例患儿作对照组,进行膀胱压力容积、压力流率和静态尿道压力分布测定。结果MPE组中,逼尿肌不稳定收缩占56.7%(68/120)例,膀胱顺应性下降占3.3%(4/120)例,最大膀胱容量/正常膀胱容量≤80%9例;CPE组中,逼尿肌不稳定收缩占80.6%(29/36)例,膀胱顺应性降低占22.2%(8/36)例,最大膀胱容量/正常膀胱容量≤80%12例,二组比较差异有显著性意义(P<0.01)。MPE组中,尿道高压66例,逼尿肌括约肌协同失调78例;CPE组中,尿道高压25例,逼尿肌括约肌协同失调21例,二组比较差异无显著性意义(P>0.05)。MPE,CPE中逼尿肌不稳定收缩、逼尿肌括约肌协同失调和尿道压增高的发生率高于对照组,而CPE中顺应性下降的发生率显著高于对照组。结论尿动力学检查结果提示MPE、CPE二组遗尿患儿尿动力学检查的必要性。

Objective To assess children with primary nocturnal enuresis (PNE) with urodynamic study. Methods Urodynamic studies were carried out in 156 children with PNE and 20 children with upper urinary tract disfunction but normal lower urinary tract function. Bladder pressure-capacity during filling, pressure-flow study during voiding and urethral pressure profilometry were performed. 120 patients with monosymptomatic primary enuresis (MPE bedwetting as the sole symptom) and 36 patients with complicated primary enuresis (CPE bedwetting associated with diurnal urinary loss, squatting, urge incontinence). Results Of 120 patients with MPE, 68 (~56.7% ) showed typical unstable detrusor contractions, 4 low-compliance bladders and 9 maximum bladder capacity (MBC)/normal bladder capacity (CBC)≤80%. Of 36 patients with CPE, 29(~80.6% ) showed detrusor instability(DI), 8 decreased bladder compliance and 12 MBC/CBC≤80%. The difference between the two groups was statistically significant (P<~0.01 ). In MPE group, 6 patients had increased urethral pressure and 78 had detrusor-sphincter dyssynergia (DSD). In CPE group 25 patients had increased urethral pressure and 21 had detrusor-sphincter dyssynergia. The incidences of DI, DSD and increased urethral pressure of MPE and CPE are significantly higher than those of the control group. The incidence of decreased bladder compliance of CPE was significantly smaller than that of control group. Conclusions Urodynamic studies play an important role in evaluation of bladder dysfunction of children with PNE. Urodynamic study reveals that the type of primary enuresis is an indicator of bladder dysfunction. The incidences of detrusor instability, decreased bladder compliance and functional bladder capacity are higher in CPE group as a whole. Urodynamic studies are required in both PNE & CPE groups.