Li Ning,Zhang Weiping,Tian Jun,et al.Urodynamic evaluations of lower urinary tract dysfunction in children with vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(02):118-123.[doi:10.3760/cma.j.cn101785-202210064-004]
尿动力检查评估膀胱输尿管反流患儿下尿路功能障碍的临床研究
- Title:
- Urodynamic evaluations of lower urinary tract dysfunction in children with vesicoureteral reflux
- Keywords:
- Urodynamics; Vesico-Ureteral Reflux; Diagnosis; Therapy; Child
- 摘要:
- 目的 探讨尿动力学(urodynamics,UDS)检查评估无神经系统及下尿路器质性病变的膀胱输尿管反流(vesicoureteral reflux,VUR)患儿下尿路功能障碍(lower urinary tract dysfunction,LUTD)的临床意义。 方法 回顾性分析2017年1月至2021年12月首都医科大学附属北京儿童医院收治的106例VUR患儿UDS 检查结果,按照有无LUTD将患儿分为有LUTD组(77例)和无LUTD组(29例),比较两组患儿膀胱容量、残余尿量(post voiding residual urine volume,PVR)以及最大尿流率等尿动力学指标。 结果 有LUTD组残余尿量97.71±93.17 mL,明显高于无LUTD组11.81±9.17 mL(t＝5.564,P＝0.008);有LUTD组最大尿流率8.82±5.01 mL/s,明显低于无LUTD组15.04±7.75 mL/s(t＝6.314,P＝0.030)。有LUTD组中,29例为低级别VUR(Ⅰ~Ⅲ级),48例为高级别VUR(Ⅳ~Ⅴ级)。低级别VUR患儿中3例膀胱顺应性减低,高级别VUR患儿中19例顺应性减低,两者比较(χ2＝7.537,P＝0.006)差异有统计学意义;低级别VUR患儿中7例PVR增加,高级别VUR患儿中23例PVR增加,两者比较(χ2＝4.298,t＝0.038)差异有统计学意义。特发性逼尿肌过度活动(idiopathic detrusor overactivity disorder,IDOD)35例(35/77,45.5%),其中19例为低级别VUR,占低级别VUR总数的65.5%(19/29);逼尿肌括约肌协同失调(dysfunctional voiding,DV)33例,其中27例为高级别VUR,占高级别VUR总数的56.3%(27/48)。 结论 PVR增多、最大尿流率降低提示VUR患儿存在LUTD的可能。高级别VUR患儿中,PVR增加更为明显、且膀胱顺应性更差。IDOD在低级别VUR中常见,DV在高级别VUR中更为常见。
- Abstract:
- Objective To evaluate the lower urinary tract dysfunction (LUTD) in children with vesicoureteral reflux (VUR) without neurological or lower urinary tract organic lesions by urodynamic examination.Methods From January 2017 to December 2021,the results of UDS examination were retrospectively reviewed for 106 VUR children.According to the presence or absence of LUTD,they were divided into LUTD group (n=77) and non-LUTD group (n=29).Such urodynamic parameters as bladder volume,residual urine volume (PVR) and maximum urine flow rate were compared between two groups.Results Residual urine volume was significantly higher in LUTD group than that in non-LUTD group (t=5.564,P=0.008).And maximum urine flow rate was lower than that in non-LUTD group (t=6.314,P=0.030).Among LUTD children,29 cases were of low grade VUR (grades Ⅰ-Ⅲ) and 48 cases high grade VUR (grades Ⅳ-Ⅴ).Bladder compliance (χ2=7.537,P=0.006) and PVR (χ2=4.298,P=0.038) were significantly different between low-grade VUR and high-grade VUR.Idiopathic detrusor overactivity disorder (IDOD) was the more common type of LUTD 45.5%(35/77) and 65.5%(19/29) in low-grade VUR.Dysfunctional voiding (DV) was more common in high-grade VUR 56.2%(27/48).Conclusion Higher PVR and lower maximum urine flow rate hint at a greater possibility of LUTD in VUR children.Children with high-grade VUR are more likely to have a greater increase in PVR and a poor bladder compliance.IDOD is common in low-level VUR while DV is more common in high-level VUR.
参考文献/References:
[1] 李怡,张潍平,杨庆林.儿童原发性膀胱输尿管反流手术治疗新进展[J].临床小儿外科杂志,2019,18(10):805-810.DOI:10.3969/j.issn.1671-6353.2019.10.001. Li Y,Zhang WP,Yang QL.Recent advances of surgery for primary vesicoureteral reflux in children[J].J Clin Ped Sur,2019,18(10):805-810.DOI:10.3969/j.issn.1671-6353.2019.10.001.
[2] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流的专家共识[J].临床小儿外科杂志,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Urology Group,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Managing Primary Vesicoureteral Reflux in Children[J].J Clin Ped Sur,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[3] Drake MJ.Fundamentals of terminology in lower urinary tract function[J].Neurourol Urodyn,2018,37(S6):S13-S19.DOI:10.1002/nau.23768.
[4] Austin PF,Bauer SB,Bower W,et al.The standardization of terminology of lower urinary tract function in children and adolescents:update report from the standardization committee of the International Children’s Continence Society[J].Neurourol Urodyn,2016,35(4):471-481.DOI:10.1002/nau.22751.
[5] Cakmak O,Tarhan H,Akarken I,et al.Can we predict vesicoureteral reflux resolution in patients with non-neurogenic lower urinary tract dysfunction?[J].Int J Urol,2019,26(6):638-642.DOI:10.1111/iju.13946.
[6] Batinic D,Milo?evic D,Topalovic-Grkovic M,et al.Vesicoureteral reflux and urodynamic dysfunction[J].Urol Int,2013,90(4):480-483.DOI:10.1159/000345713.
[7] Radmayr C,Tekgul S.Paediatric urology and the dilemma of low-quality evidence for the management of common urological conditions (vesicoureteral reflux,lower urinary tract dysfunction,undescended testis) in children[J].Eur Urol Focus,2017,3(2/3):308-309.DOI:10.1016/j.euf.2017.03.012.
[8] 黄书满,文建国,高新梅,等.小儿膀胱输尿管反流87例相关尿动力学因素研究[J].中华小儿外科杂志,2014,35(9):675-678.DOI:10.3760/cma.j.issn.0253-3006.2014.09.009. Huang SM,Wen JG,Gao XM,et al.Predictive factors of vesicoureteral reflux in 87 children[J].Chin J Pediatr Surg,2014,35(9):675-678.DOI:10.3760/cma.j.issn.0253-3006.2014.09.009.
[9] Nordenstr?m J,Sj str?m S,Sillén U,et al.The Swedish infant high-grade reflux trial:UTI and renal damage[J].J Pediatr Urol,2017,13(2):146-154.DOI:10.1016/j.jpurol.2016.12.023.
[10] Sillén U,Brandstr?m P,Jodal U,et al.The Swedish reflux trial in children:v.Bladder dysfunction[J].J Urol,2010,184(1):298-304.DOI:10.1016/j.juro.2010.03.063.
[11] 吕宇涛,文建国,黄书满,等.影像尿动力学评估先天性膀胱输尿管返流患儿的膀胱功能障碍[J].中华实用儿科临床杂志,2014,29(17):1310-1313.DOI:10.3760/j.issn.2095-428X.2014.17.008. Lyu YT,Wen JG,Huang SM,et al.Evaluations of bladder dysfunction in children with congenital vesical ureteral reflux through videourodynamic examination[J].Chin J Appl Clin Pediatr,2014,29(17):1310-1313.DOI:10.3760/j.issn.2095-428X.2014.17.008.
[12] Babu R,Gopinath V.Role of uroflowmetry with electromyography in the evaluation of children with lower urinary tract dysfunction[J].Indian J Urol,2015,31(4):354-357.DOI:10.4103/0970-1591.166469.
[13] L?ckgren G,Sk?ldenberg E,Stenberg A.Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel is effective in vesicoureteral reflux associated with bladder dysfunction[J].J Urol,2007,177(3):1124-1129.DOI:10.1016/j.juro.2006.10.094.
[14] Horasanli K,Bayar G,Acinikli H,et al.Lower urinary tract dysfunction in pediatric patients after ureteroneocystostomy due to vesicoureteral reflux:long-term follow-up[J].Low Urin Tract Symptoms,2019,11(2):O48-O52.DOI:10.1111/luts.12213.
相似文献/References:
[1]曹永胜,蔡盈,潮敏,等.尿动力学检测在儿童尿频症中的应用[J].临床小儿外科杂志,2007,6(02):9.
[2]鲁中原 张建 张潍平 冀圆琦 李明磊 屈彦超. 脊髓脊膜膨出患儿尿动力学改变与上尿路损害的关系探讨[J].临床小儿外科杂志,2011,10(06):420.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):420.
[3]王朝旭,张潍平,宋宏程,等.经尿道瓣膜切开手术对后尿道瓣膜合并膀胱输尿管反流的影响[J].临床小儿外科杂志,2019,18(03):225.[doi:10.3969/j.issn.1671-6353.2019.03.013]
Wang Chaoxu,Zhang Weiping,Song Hongcheng,et al.Outcome of vesicoureteral reflux in patients with posterior urethral valves after primary valve ablation[J].Journal of Clinical Pediatric Surgery,2019,18(02):225.[doi:10.3969/j.issn.1671-6353.2019.03.013]
[4]李怡,张潍平,杨庆林.儿童原发性膀胱输尿管反流手术治疗的新进展[J].临床小儿外科杂志,2019,18(10):805.[doi:10.3969/j.issn.1671-6353.2019.10.001]
Li Yi,Zhang Weiping,Yang Qinglin.Recent advances of surgery for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2019,18(02):805.[doi:10.3969/j.issn.1671-6353.2019.10.001]
[5]陈光杰,王晓豪,赵一俊,等.透明质酸钠凝胶注射治疗原发性膀胱输尿管反流的效果分析[J].临床小儿外科杂志,2019,18(10):820.[doi:10.3969/j.issn.1671-6353.2019.10.004]
Chen Guangjie,Wang Xiaohao,Zhao Yijun,et al.A preliminary report of endoscopic injection of dextranomer/hyaluronic acid in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2019,18(02):820.[doi:10.3969/j.issn.1671-6353.2019.10.004]
[6]姜大朋,王琪,史政洲,等.原发性膀胱输尿管反流在2月龄以下婴儿发热性尿路感染人群中的临床特点[J].临床小儿外科杂志,2019,18(10):825.[doi:10.3969/j.issn.1671-6353.2019.10.005]
Jiang Dapeng,Wang Qi,Shi Zhengzhou,et al.Pathogenic characteristics of primary vesicoureteral reflux in infants aged under 2 months with febrile urinary tract infection[J].Journal of Clinical Pediatric Surgery,2019,18(02):825.[doi:10.3969/j.issn.1671-6353.2019.10.005]
[7]刘鑫,刘舸,杨屹.儿童原发性膀胱输尿管反流手术干预的相关因素分析[J].临床小儿外科杂志,2019,18(10):830.[doi:10.3969/j.issn.1671-6353.2019.10.006]
Liu Xin,Liu Ge,Yang Yi.Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2019,18(02):830.[doi:10.3969/j.issn.1671-6353.2019.10.006]
[8]王文杰,宋宏程,谢向辉,等.肾盂输尿管连接部梗阻合并同侧原发性膀胱输尿管反流诊治分析[J].临床小儿外科杂志,2019,18(10):835.[doi:10.3969/j.issn.1671-6353.2019.10.007]
Wang Wenjie,Song Hongcheng,Xie Xianghui,et al.Experiences of diagnosing and treating ureteropelvic junction obstruction plus ipsilateral primary ureteral reflux[J].Journal of Clinical Pediatric Surgery,2019,18(02):835.[doi:10.3969/j.issn.1671-6353.2019.10.007]
[9]徐延波,陈海琛,马丽丽,等.气膀胱下Politano-Leadbetter输尿管移植术的经验分析[J].临床小儿外科杂志,2020,19(08):741.[doi:10.3969/j.issn.1671-6353.2020.08.015]
Xu Yanbo,Chen Haichen,Ma Lili,et al.Application of Politano-Leadbetter in laparoscopic pneumovesicum approach for ureteral reimplantation for congenital malformation of vesicoureteral junction in children: a report of 10 children[J].Journal of Clinical Pediatric Surgery,2020,19(02):741.[doi:10.3969/j.issn.1671-6353.2020.08.015]
[10]吕磊,文建国.儿童尿流动力学检查相关术语解读与临床应用[J].临床小儿外科杂志,2020,19(11):973.[doi:10.3969/j.issn.1671-6353.2020.11.003]
Lü Lei,Wen Jianguo.Term interpretations and clinical applications of urodynamic examinations in children[J].Journal of Clinical Pediatric Surgery,2020,19(02):973.[doi:10.3969/j.issn.1671-6353.2020.11.003]
备注/Memo
收稿日期:2022-10-30。
基金项目:北京市医院管理中心儿科学科协同发展中心专项(XTZD20180303)
通讯作者:张潍平,Email:zhangwpp@163.com