De Gennaro M, Capitanucci M L, Mosiello G, Caione P, Silveri M
Department of Paediatric Surgery, Urodynamics and Paediatric Urology Units, Ospedale Paediatrico 'Bambino Ges¿u', Palidoro, Rome, Italy.
BJU Int. 2000 Jun;85(9):1104-8. doi: 10.1046/j.1464-410x.2000.00700.x.
To determine whether bladder dysfunction in boys with posterior urethral valves (PUV) changes from a uniform pattern of hypercontractility during infancy to the hypocontractility found in adolescence, by reviewing serial urodynamic studies.
Thirty boys with PUV and no voiding symptoms underwent a total of 86 urodynamic tests (mean 2.8 each). The first urodynamic study was undertaken at 1-4 years of age in 15 boys and at 5-13 years in 15. They were re-evaluated at least 3 years later; 15 patients underwent the first and last urodynamic study, respectively, at a mean age of 2.8 and 7.7 years (group A), 10 boys at 6.2 and 8. 8 years (group B) and five at 9.4 and 15.2 years (group C). In 10 boys aged > 5 years the first and last pressure-flow studies (PFS) were analysed using an advanced analysis (PFA) to better identify hypocontractility.
Bladder dysfunction was found in 21 of 30 (70%) boys at the first evaluation and in 18 (60%) at the last. In 25 boys the urodynamic pattern changed. Of the 15 boys in group A, 10 of 12 who had hypercontractility changed to normal (seven), low compliance (one) or hypocontractility (two), and two remained stable; two of the remaining three with normal urodynamic studies changed to hypocontractility, while one was unchanged. Among the 10 boys in group B, six with hypercontractility changed to normal (three) or hypocontractility (three); two with normal urodynamic findings and one with low compliance changed to hypocontractility. Of the five boys in group C who showed severe hypocontractility after puberty, three had a normal pattern, one low compliance and one hypercontractility before puberty. The PFA showed a 'weak' detrusor in four of the seven boys who were considered normal on standard PFS. At the urodynamic follow-up, the PFA pattern changed to a 'weak' detrusor in four boys who had a normal (two) or strong (two) detrusor at the first evaluation.
Bladder dysfunction in boys with PUV changes during childhood and through adolescence. The urodynamic pattern of hypercontractility generally found soon after valve ablation gradually changes to hypocontractility in many boys and this pattern seems to be the rule after puberty. The evidence from this series supports the hypothesis that long-term detrusor hyperactivity in boys with PUV leads to detrusor failure, but a longitudinal 15-year follow-up from birth to puberty is needed to validate this concept.
通过回顾系列尿动力学研究，确定后尿道瓣膜（PUV）男孩的膀胱功能障碍是否从婴儿期的一致高收缩模式转变为青春期出现的低收缩模式。
30例患有PUV且无排尿症状的男孩共接受了86次尿动力学检查（平均每人2.8次）。15名男孩在1至4岁时进行了首次尿动力学研究，另外15名在5至13岁时进行。至少3年后对他们进行重新评估；15例患者分别在平均年龄2.8岁和7.7岁时进行了首次和最后一次尿动力学研究（A组），10名男孩在6.2岁和8.8岁时进行（B组），5名在9.4岁和15.2岁时进行（C组）。对10名年龄大于5岁的男孩，使用高级分析（PFA）分析首次和最后一次压力-流率研究（PFS），以更好地识别低收缩性。
首次评估时，30名男孩中有21名（70%）存在膀胱功能障碍，最后评估时为18名（60%）。25名男孩的尿动力学模式发生了变化。A组的15名男孩中，12名高收缩性的男孩中有10名转变为正常（7名）、低顺应性（1名）或低收缩性（2名），2名保持稳定；其余尿动力学研究正常的3名男孩中有2名转变为低收缩性，1名未改变。B组的10名男孩中，6名高收缩性的男孩转变为正常（3名）或低收缩性（3名）；2名尿动力学结果正常和1名低顺应性的男孩转变为低收缩性。C组的5名男孩青春期后表现为严重低收缩性，其中3名青春期前模式正常，1名低顺应性，1名高收缩性。PFA显示，在标准PFS中被认为正常的7名男孩中有4名逼尿肌“弱”。在尿动力学随访中，4名首次评估时逼尿肌正常（2名）或强（2名）的男孩，其PFA模式转变为逼尿肌“弱”。
患有PUV的男孩膀胱功能障碍在儿童期和青春期会发生变化。瓣膜切除后不久通常出现的高收缩性尿动力学模式在许多男孩中逐渐转变为低收缩性，这种模式似乎是青春期后的规律。本系列研究的证据支持以下假设，即患有PUV的男孩长期逼尿肌过度活动会导致逼尿肌功能衰竭，但需要从出生到青春期进行15年的纵向随访来验证这一概念。
