Tian Jun,Zhang Weiping,Sun Ning,et al.Relationship between bladder dysfunction and upper urinary tract damage after anterior urethral valve resection[J].Journal of Clinical Pediatric Surgery,,19():996-1001.[doi:10.3969/j.issn.1671-6353.2020.11.007]
Relationship between bladder dysfunction and upper urinary tract damage after anterior urethral valve resection
- Keywords:
- Anterior Urethral Valve; Surgical Procedures; Operative; Urodynamics
- CLC:
- R726.1;R726.9;R694;R695
- Abstract:
- Objective To explore the urodynamic risk factors for continuous damage of upper urinary tract after anterior urethral valve (AUV) resection.Methods A retrospective analysis was performed for 26 children undergoing AUV resection from January 2007 to January 2020.The mean age was 40.8(5-168) months after resection and the mean occurring time 66(4-150) months.Urodynamic examinations were performed.Before and after operation,blood biochemical tests of urea nitrogen and creatinine,ultrasonography of urinary system,intravenous pyelography (IVP) and voiding cystourethrogram (VCUG) were performed.Hydronephrosis and vesicoureteral reflux were compared before and after resection for analyzing the risk factor for continuous damage of upper urinary tract after AUV.Results There were 15 cases (24 sides) with hydroureteronephrosis,(57.7%,15/26) and 8 cases (11 sides) with vesicoureteral reflux (30.8%,8/26) before resection.Hydroureteronephrosis disappeared in 7 sides of 5 cases (19.2%) and vesicoureteral reflux was cured in 2 cases (3 sides).There were 10 cases (17 sides) with hydroureteronephrosis after resection (38.5%,10/26) and 6 cases (8 sides) with vesicoureteral reflux (23.1%,6/26).Hydroureteronephrosis in 7 cases (11 sides) worsened than that before operation,26.9%(7/26),including 4 cases with 6 sides of vesicoureteral reflux.According to postoperative hydroureteronephrosis and vesicoureteral reflux,they were divided into upper urinary tract damage aggravation group (n=7) and upper urinary tract damage reduction/disappearance group (n=19).Urodynamic examination after resection showed that lower urinary tract obstruction or suspected obstruction persisted in 5 cases of upper urinary tract damage aggravation group.However,no obstruction was found in 19 children in upper urinary tract damage reduction/disappearance group (P<0.05).Also significant inter-group differences existed in mean maximal flow rate,bladder compliance and maximal detrusor pressure during micturition (P<0.05).In 5 cases,bladder neck was not completely opened during micturition.And bladder wall thickening,trabecular changes and bladder pseudodiverticulum formation were found in 3 cases,especially thickening of bladder base and tissue around inner bladder orifice.Conclusion AUV is a rare obstructive disease of lower urinary tract.Damage of upper urinary tract persists or worsens after resection.The urodynamic risk factors of bladder dysfunction are elevated maximal detrusor pressure,low maximal flow rate,low bladder compliance and obstruction of pressure flow chart.These factors may be correlated with abnormal bladder neck function and structure in AUV children.
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Memo
收稿日期:2020-08-16。
基金项目:北京市医院管理局"登峰"人才培养计划（编号：DFL20151102）
通讯作者:张潍平,Email:zhangwpp@163.com