小儿后尿道瓣膜切除后合并排尿异常的尿动力学研究

Effects of abnormal micturition in boys with posterior urethral valves after valve ablation

目的探讨经尿道镜后尿道瓣膜切除术后伴有排尿异常患儿上尿路、膀胱功能及预后。方法回顾性分析2002年7月至2012年2月收治的行尿道镜电灼后尿道瓣膜术后获得随访的58例患儿的病例资料，归纳总结其存在的临床症状、影像学异常以及尿动力学检查结果，并将其分为排尿正常组（10例）和排尿异常组（48例），对其年龄分布、上尿路情况、尿动力学参数进行比较分析。结果术后仍存在的临床症状有：尿失禁18例（31.0％），反复泌尿系感染8例（13.8％），排尿费力、滴尿15例（25.9％），尿频4例（6.9％），尿不尽5例（8.6％），无明显症状10例（17.2％），肾功能衰竭3例（5.2％）。影像学检查示：术后仍存在双肾积水者50例91侧（86.2％），存在膀胱输尿管反流23例27侧（39.7％）。58例患儿中56例（96.6％）存在不同程度的尿动力学异常。逼尿肌不稳定者占16例（27.6％）；逼尿肌收缩无力者6例（10.3％）；残余尿量〉10m1者25例（43.1％）；腹压参与排尿者23例（39.7％）。比较排尿正常组与排尿异常组单侧肾输尿管积水比例（11.1％ vs 88.9％）、双侧肾输尿管积水比例（9.8％vs90.2％）、单侧膀胱输尿管反流比例（6.7％ vs 93.3％）、双侧膀胱输尿管反流比例（12.5％ vs 87.5％），差异均具有统计学意义（P〈0.05）。排尿正常组与排尿异常组逼尿肌漏尿点压力[（29.1±5．5）cmH2O vs （50.4±4.8）cmH203、膀胱顺应性[（12.1±3.8）ml／cmH20vs（4.0±0.1）ml／cmH20]、残余尿量比较[（21.3±8.1）ml vs （45.7±9.6）m1]，差异均有统计学意义（P〈0.05）。结论后尿道瓣膜患儿解除梗阻后多数患儿仍存在不同程度膀胱功能问题，排尿异常组膀胱功能及上尿路情况明显差于排尿正常组。后尿道瓣膜患儿术后应注意排尿情况，定期做尿动力学检查，对症处理，以更好的保护肾功能。

Objective To explore the effects of abnormal micturition in the prognosis of boys with posterior urethral valve （PUV） after valve ablation. Methods Retrospective analyses were conducted for the clinical data of 58 boys with a diagnosis of PUV during July 2002 to February 2012 after posterior urethral valve ablation. Also the clinical symptoms, imaging abnormalities and urine dynamic test results and its changes were recorded and analyzed. And they were divided into normal and abnormal micturition groups to analyze the age distribution, upper tract and urinary dynamics parameters. Results The postoperative symptoms included urinary incontinence （18/58; 31.0%）, urinary tract infections （8/58; 13.8%）,arduous ~ dribbling micturition （15/58; 25.9%）, urinary frequency （4/58; 6.9%） and renal failure （3/58; 5.2%）. Imaging examinations showed bilateral hydronephrosis （50/58; 86. 2%） and countercultural reflux （20/58; 39. 7%）. Urine dynamic test showed different degree of abnormal urine dynamics （56/58;96.6% ）, detrusor instability （n = 16, 27.6%）, powerless Detrusor contractions （n = 6, 10.3%）, residual urine volume 〉 10 ml （n = 25, 43.1%） and abdominal pressure in urination （n = 23,39. 7 %）. The ages of micturition abnormal group were older and hydronephrosis in normal micturition group was less than abnormal micturition group. And the bladder ureter reflux ratio of micturition abnormal group was significantly higher than that of normal group. Bladder compliance and residual urine volume had obvious statistical significance. The maximum bladder capacity comparison and urine flow rate showed no obvious statistical difference between two groups. Conclusions There are many subsequent problems in boys with PUV after valve ablatiorL Abnormal micturition influences the prognosis. Urodynamic studies may reveal the existence and rate of bladder dysfunction. For children with PUV, regular urodynamic studies should be performed to evaluate bladder function and prevent further damage to upper urinary tract so as to improve the prognosis.