尿流动力学检查对神经源性下尿路功能障碍的临床意义

Clinical application of urodynamic examination for neurogenic lower urinary tract dysfunction

目的评估尿流动力学检查对神经源性下尿路功能障碍的临床意义。方法回顾性收集我院2012年2月至2014年4月34例神经源性下尿路功能障碍患者的尿流动力学检查资料，按临床症状分储尿期症状组、排尿期症状组及储尿期与排尿期症状混合组，分析总结各组患者的尿动力特点。结果以储尿期症状为主的患者全部都有膀胱感觉过敏及逼尿肌过度活动；以排尿期症状为主的患者90％（18例）逼尿肌无自主收缩，60％（12例）膀胱感觉减退；同时有储尿期及排尿期症状的患者55．5％（5例）逼尿肌无自主收缩，33．3％（3例）逼尿肌一括约肌协同失调，33．3％（3例）膀胱感觉过敏，33．3％（3例）膀胱顺应性降低。结论尿流动力学检查能明确神经损害后下尿路功能障碍的模式，尤其是能够检查出膀胱顺应性是否降低，有利于指导临床制定治疗方案，更好地保护上尿路功能。尿流动力学检查在神经源性下尿路功能障碍的临床应用中是可靠及必要的。

Objective To evaluate the clinical value of urodynamic examination in neurogenic lower urinary tract dysfunction. Methods Urodynamic data of 34 cases of neurogenic lower urinary tract dysfunction in our hospital from February 2012 to April 2014 was retrospectively analyzed. All patients were divided into three groups according to clinical symptoms including storage disorders, voiding disorders, both storage and voiding disorders. Results All patients with storage disorders had increased bladder sensation and detrusor overactivity. In patients with voiding disorders, 18 cases （90%） were lack of spontaneous detrusor contractility, 12 cases （60%） had reduced bladder sensation. In patients with both storage and voiding disorders, 5 cases （55.5%） were lack of spontaneous detrusor contractility, 3 cases （33.3%） had detrusor-sphincter dyssynergia, 3 cases （33.3%） had increased bladder sensation, 3 cases （33.3%） had reduced bladder compliance. Conclusions Urodynamic examination is helpful to define the type of lower urinary tract dysfunction after nerve damage, especially to detect whether bladder compliance is impaired or not, which may be useful for making clinical decision and protecting upper urinary tract function. Urodynamic examination is reliable and essential for the treatment ofneurogenic lower urinary tract dysfunction.