Cai Miao,Li Qi,Wu Shengde,et al.Analysis of risk factors for bladder dysfunction in children with nocturnal enuresis[J].Journal of Clinical Pediatric Surgery,2024,(03):234-237.[doi:10.3760/cma.j.cn101785-202112045-006]
遗尿儿童发生膀胱功能障碍的危险因素分析
- Title:
- Analysis of risk factors for bladder dysfunction in children with nocturnal enuresis
- Keywords:
- Enuresis; Bladder Dysfunction; Power of Urine; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨遗尿患儿发生膀胱功能障碍的危险因素。 方法 本研究为回顾性研究,选取2020年9月至2022年9月在重庆医科大学附属儿童医院泌尿外科排尿障碍诊治中心进行尿动力压力-流率检查的343例遗尿患儿为研究对象,根据尿动力检查结果将患儿分为有膀胱功能障碍组(n=157)和无膀胱功能障碍组(n=186),比较两组一般情况(性别、父母文化、居住环境、睡前饮水、遗尿史、大便情况、日间症状、每周遗尿次数、膀胱容量、尿流率、残余尿、脊柱裂)、尿常规、泌尿系超声、X线骶尾椎平片、自由尿流率。 结果 343例遗尿患儿中,男性200例、女性143例,就诊年龄(7.85±2.36)岁。男性(OR=2.156,95％CI:1.085~4.285)、伴有日间症状(OR=4.471,95％CI:2.229~8.967)、功能性膀胱容量减小(OR=20.651,95％CI:9.094~46.895)、遗尿次数每周超过4次(OR=2.339,95％CI:1.131~4.838)、尿流率降低(OR=3.196,95％CI:1.360~7.510)、隐性脊柱裂(OR=2.359,95％CI:1.160~4.794)是儿童发生膀胱功能障碍的独立危险因素。 结论 男性、伴有日间症状、隐性脊柱裂、遗尿次数＞4次、生理性膀胱容量减小以及尿流率降低可能与遗尿儿童发生膀胱功能障碍有关,这些遗尿患儿有必要常规行尿动力学检查了解膀胱功能,为规范诊疗提供依据。
- Abstract:
- Objective To explore the risk factors of bladder dysfunction in children with nocturnal enuresis (NE).Methods From September 2020 to September 2022,343 NE children receiving urinary dynamic pressure-flow rate examination at Urinary Disorders Diagnosis and Treatment Center were selected as study subjects.According to the urodynamic results,they were assigned into two groups of bladder dysfunction (n=157) and non-dysfunction (n=186).Two groups were compared with regards to general profiles (gender,parental education,living environment,bedtime drinking water,history of enuresis,stool,daytime symptoms,weekly frequency of enuresis,bladder volume,urinary flow rate,residual urine & spina bifida),urinary routine,urological system ultrasonography,bococcygeal plain film and free urinary flow rate.Results There were 200 boys and 143 girls with a treatment age of (7.85±2.36) years.Male (OR=2.156,95%CI:1.085-4.285),daytime symptoms(OR=4.471,95%CI:2.229-8.967),lowered functional bladder volume (OR=20.651,95%CI:9.094-46.895),weekly frequency of enuresis ＞4 times (OR=2.339,95%CI:1.131-4.838),reduced urinary flow rate (OR=3.196,95%CI:1.360-7.510) and occult spina bifida (OR=2.359,95%CI:1.160-4.794) were independent risk factors for bladder dysfunction in children.Conclusions Male,daytime symptoms,occulted spina bifida,weekly frequency of enuresis ＞4 times,lowered physiologic bladder volume and decreased urinary flow rate are risk factors for bladder dysfunction in NE children.Routine urodynamic examination is necessary to understand bladder function and provide rationales for standardized management.
参考文献/References:
[1] 陈咏梅,黄艳,熊琼珍,等.252例儿童夜遗尿症的临床特征分析[J].临床小儿外科杂志,2021,20(6):588-591.DOI:10.12260/lcxewkzz.2021.06.015.Chen YM,Huang Y,Xiong QZ,et al.Retrospective analysis of clinical characteristics of nocturnal enuresis in children:a report of 252 cases[J].J Clin Ped Sur,2021,20(6):588-591.DOI:10.12260/lcxewkzz.2021.06.015.
[2] Miyazato M,Gakiya M,Ashikari A,et al.Evaluation of the influence of a history of childhood nocturnal enuresis on nighttime urinary frequency and the causes of nocturia in adults[J].Urology,2022,164:106-111.DOI:10.1016/j.urology.2022.01.007.
[3] Petros PE,Garcia-Fernandez A.Cure of enuresis/bowel dysfunction in children may provide insights for adult dysfunctions[J].Tech Coloproctol,2021,25(3):351-353.DOI:10.1007/s10151-021-02410-1.
[4] Hussong J,Rosenthal A,Bernhardt A,et al.State and trait anxiety in children with incontinence and their parents[J].Clin Child Psychol Psychiatry,2021,26(4):1243-1256.DOI:10.1177/13591045211033175.
[5] Van Batavia JP,Combs AJ.The role of non-invasive testing in evaluation and diagnosis of pediatric lower urinary tract dysfunction[J].Curr Urol Rep,2018,19(5):34.DOI:10.1007/s11934-018-0784-1.
[6] Yavuz A,Bayar G,Kilinc MF,et al.The relationship between nocturnal enuresis and spina bifida occulta:a prospective controlled trial[J].Urology,2018,120:216-221.DOI:10.1016/j.urology.2018.07.038.
[7] 文建国,牛建华,吴军卫,等.隐性脊柱裂对儿童原发性夜间遗尿症治疗的影响[J].中华小儿外科杂志,2016,37(11):851-855.DOI:10.3760/cma.j.issn.0253-3006.2016.11.011.Wen JG,Niu JH,Wu JW,et al.Impact of spina bifida occulta on the treatments of primary nocturnal enuresis[J].Chin J Pediatr Surg,2016,37(11):851-855.DOI:10.3760/cma.j.issn.0253-3006.2016.11.011.
[8] Peh WYX,Raczkowska MN,Teh Y,et al.Closed-loop stimulation of the pelvic nerve for optimal micturition[J].J Neural Eng,2018,15(6):066009.DOI:10.1088/1741-2552/aadee9.
[9] 文建国,王庆伟,文建军,等.411例遗尿症儿童和青少年的家族史和家系分析[J].中华泌尿外科杂志,2007,28(5):316-318.DOI:10.3760/j:issn:1000-6702.2007.05.008.Wen JG,Wang QW,Wen JJ,et al.Family lineage and segregation studies on children with nocturnal enuresis:a report of 411 cases[J].Chin J Urol,2007,28(5):316-318.DOI:10.3760/j:issn:1000-6702.2007.05.008.
[10] J?rgensen CS,Horsdal HT,Rajagopal VM,et al.Identification of genetic loci associated with nocturnal enuresis:a genome-wide association study[J].Lancet Child Adolesc Health,2021,5(3):201-209.DOI:10.1016/S2352-4642(20)30350-3.
相似文献/References:
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备注/Memo
收稿日期:2021-12-17。
基金项目:国家儿童健康与疾病临床医学研究中心临床医学研究一般项目(NCRCCHD-2020-GP-04)
通讯作者:魏光辉,Email:u806806@cqmu.edu.cn