脊髓发育不良和隐性骶椎裂致神经源性膀胱功能障碍的尿动力学表现

Urodynamics study in patients with neurogenic bladder cause by myelodysplasia and hemirachischisis

为了解脊髓发育不良和隐性骶椎裂对泌尿系统的影响，对３４例有泌尿系统症状的患者行尿动力学检查和辅助检查。结果显示有反射性膀胱２１例（６１．７％），其中逼尿肌外括约肌协同失调１３例，排尿困难为主要表现；逼尿肌外括约肌协同正常８例，急迫性尿失禁为主要表现。无反射性膀胱１３例（３８．５％），排尿困难、尿潴留为主要表现。１２例膀胱颈口开放患者９例有尿失禁，最大尿道闭合压为３．１７±１．４０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），２２例膀胱颈口闭合患者最大尿道闭合压为７．７７±３．５０ｋＰａ（Ｐ＜０．０１）。１５例ＩＶＵ显示有上尿路损害的患者排尿期膀胱压力为平均８．０１±４．３０ｋＰａ，１９例无上尿路损害的患者排尿期膀胱压力平均为３．０６±１．２０ｋＰａ，（Ｐ＜０．０１）。综合分析显示患者临床症状和尿动力学表现与脊髓损伤平面无对应关系。

To investigate the effect of myelodysplasia and hemirachischisis on urological system, urodynamic studies were undertaken in 34 patients with myelodysplasia and hemirachischisis presenting with urological symptoms. The results demonstrated that the symptoms may be caused by reflexia neurogenic bladder as in 21 cases (61.7%), or areflexia neurogenic bladder as in 13 cases, (38.3%). 13 cases presenting with difficult micturition were caused by vesicoexternal sphincter dyssynergia while 8 cases with incontinence have normal vesicoexternal sphincter function. The urethral closure pressure (3.17±1.40kPa) in 12 patients with open vesical neck was much lower than in 22 patients with vesical neck closed (7.77±3.50kPa). 9/12 of open vesical neck cases have incontinence and 8/22 of closed vesical neck have incontinence. Voiding bladder pressure in 15 patient with upper urinary tract damage was 8.01±4.30kPa which was much higher than that(3.06±1.20kPa) in 19 patients without upper urinary tract damage(P<0.01). Clinical and urodynamics presentation was not related to the level of spinal cord injury.