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目的:分析我院非神经源性排尿功能障碍小儿的尿动力学结果,探讨尿动力学检查在小儿非神经性排尿功能障碍疾病诊断中的临床意义及应用价值。方法:回顾性分析2015年11月~2017年3月我院泌外门诊22例非神经源性排尿功能障碍小儿尿动力学检查结果。其中男16例,女6例,年龄2~14岁,平均(7.86±3.66)岁。所有病例均经过详细询问病史、体格检查、实验室检查和影像学检查(B超、MRI等)排除神经系统疾患。根据国际尿控协会标准方法进行尿动力学检查,记录最大尿流率、尿流时间、排尿模式、剩余尿、初感尿意、最大膀胱容量、顺应性、排尿期逼尿肌压力、有无逼尿肌过度活动、有无逼尿肌括约肌协同失调、静态尿道压和尿道关闭压。按照尿急尿频、遗尿、排尿困难分组比较各项尿动力检查参数。结果:自由尿流率测定:男和女平均最大尿流率分别为(14.69±7.59)ml/s和(32.2±12.3)ml/s(P<0.05),平均尿流时间分别为(20.72±11.96)s和(12.68±7.36)s(P<0.05)。尿频尿急组、遗尿组、排尿困难组三组之间最大尿流率,尿流时间差异有统计学意义(P<0.05)。自由尿流率排尿模式:正常钟形曲线10例,低平曲线7例,间歇曲线4例,间歇低平曲线1例。尿频尿急组、遗尿组、排尿困难组三组之间剩余尿有统计学意义(P<0.05)。结论:小儿非神经源性排尿功能障碍类疾病常见,病因复杂,临床表现多样化,尿动力学检查可为各种排尿功能障碍的鉴别诊断、治疗方案的选择以及术后疗效的评价提供有效的客观证据。在小儿不配合,无法完成压力流率测定时,结合自由尿流率,排尿模式和剩余尿(可用B超测定),加上病史可以初步判断排尿功能障碍类型,协助治疗。
Objective: To analyze the urodynamic results of children with non-neurogenic voiding dysfunction in our hospital and to explore the clinical significance and clinical value of urodynamic tests in the diagnosis of non-neurogenic voiding dysfunction in children. Methods: A retrospective analysis of 22 children with non-neurogenic voiding dysfunction in our hospital from November 2015 to March 2017 was performed urodynamic examination. Including 16 males and 6 females, aged 2 to 14 years, with an average (7.86 ± 3.66) years. All cases were detailed history, physical examination, laboratory tests and imaging studies (B ultrasound, MRI, etc.) to rule out neurological disorders. According to the International Urine Control Association standard method for urodynamic examination, recording the maximum flow rate, urinary flow time, urination mode, residual urine, primary urinary intention, maximum bladder capacity, compliance, urinary detrusor pressure, with or without force Urinary muscle over activity, with or without detrusor sphincter dyskinesia, static urethral pressure and urethral pressure. In accordance with urinary urgency, urinary frequency, enuresis, dysuria group urodynamic examination parameters. Results: The average urinary flow rate was (14.69 ± 7.59) ml / s and (32.2 ± 12.3) ml / s respectively (P <0.05), and the mean urinary flow time was (20.72 ± 11.96) s and (12.68 ± 7.36) s (P <0.05), respectively. Urinary frequency urgency group, enuresis group, dysuria group, the maximum urinary flow rate, urinary flow time difference was statistically significant (P <0.05). Free urinary flow rate of urination patterns: normal bell curve in 10 cases, low flat curve in 7 cases, intermittent curve in 4 cases, intermittent low flat curve in 1 case. Urinary frequency urgency group, enuresis group, dysuria group remaining urine between the three groups was statistically significant (P <0.05). Conclusion: Non-neurogenic voiding dysfunction is common in children with complicated etiology and diversified clinical manifestations. Urodynamic examination can provide an effective method for the differential diagnosis of various voiding dysfunctions, the selection of treatment options and the evaluation of postoperative efficacy Objective evidence In pediatric does not cooperate, can not complete the pressure flow rate determination, combined with free urine flow rate, urination pattern and residual urine (available B-measured), combined with medical history to determine the type of urinary dysfunction, assist treatment.