Samuel M, Boddy S A, Wang K
Department of Paediatric Surgery, St. George's Hospital, London, England.
J Urol. 2001 Jun;165(6 Pt 2):2335-40. doi: 10.1016/S0022-5347(05)66198-8.
We assess night and day function of the neuropathic bladder in children with neurogenic vesical dysfunction by overnight urodynamic monitoring and conventional static cystometrogram. Overnight urodynamics as a diagnostic tool was evaluated and its reproducibility analyzed.
In 18 months 3 boys and 3 girls 6 to 14 years old (mean age plus or minus standard deviation 10.3 +/- 3.3) were studied prospectively. Each child was evaluated on 4 separate occasions with 2-daytime cystometrograms at a standard fill rate of 10 ml. per minute and 2 overnight urodynamic studies for 8 hours using a Urolog Recorder. All 6 children were interviewed regarding the acceptability, repeatability and compliance to overnight urodynamics.
Bladder capacity was not significantly different during each episode for either of the 2 tests. Mean bladder pressures in 2 children showed stable detrusor activity on cystometry (2 +/- 1.4 cm. H2O) and overnight urodynamics (0.4 +/- 0.5, r = 0.9). Detrusor compliance was not impaired in these 2 children. Four patients had frank detrusor instability with a mean bladder pressure of 50.6 +/- 17.4 cm. H2O on cystometry versus 35.9 +/- 5.2 on overnight urodynamics (r = 0.9). Bladder compliance was severely impaired in these 4 patients. Compliance at potential bladder capacity for patient age was 6.6 +/- 2.1 ml./cm. H2O for cystometry versus 9.2 +/- 3.4 for overnight urodynamics (p = 0.26, r = 0.9). Compliance at actual bladder capacity was 3.4 +/- 1.2 ml./cm. H2O for cystometry versus 3.8 +/- 0.8 for overnight urodynamics (p = 0.28, r = 0.9). There was good correlation between daytime cystometry and overnight urodynamics (p <0.001, Pearson's coefficient correlation 0.92, 95% confidence interval 0.90 to 0.94). A kappa statistical analysis showed good agreement between cystometry and overnight urodynamics for stable bladder and frank detrusor instability (kappa = 0.9). Replicated measurements of the same patient by the same observer had an error of variance of 1.7 cm. H2O with a narrow confidence interval, indicating the measurement error was small and that overnight urodynamics can be reproduced with relative accuracy within an individual. All 6 children preferred overnight urodynamics to cystometry.
There was good correlation between bladder behavior day and night. Overnight urodynamics were accurate in predicting detrusor activity, and well tolerated and less embarrassing for a child with neurogenic vesical dysfunction.
我们通过夜间尿动力学监测和传统静态膀胱测压法评估神经源性膀胱功能障碍患儿的神经病变膀胱的昼夜功能。评估夜间尿动力学作为一种诊断工具，并分析其可重复性。
在18个月的时间里，对3名6至14岁（平均年龄±标准差为10.3±3.3）的男孩和3名女孩进行了前瞻性研究。每个孩子在4个不同的时间点接受评估，包括2次以每分钟10毫升的标准充盈速度进行的日间膀胱测压，以及2次使用泌尿外科记录仪进行的长达8小时的夜间尿动力学研究。对所有6名儿童就夜间尿动力学的可接受性、可重复性和依从性进行了访谈。
两种测试中的每一次，膀胱容量均无显著差异。2名儿童的平均膀胱压力显示，膀胱测压时逼尿肌活动稳定（2±1.4厘米水柱），夜间尿动力学时为0.4±0.5（r = 0.9）。这2名儿童的逼尿肌顺应性未受损。4例患者存在明显的逼尿肌不稳定，膀胱测压时平均膀胱压力为50.6±17.4厘米水柱，夜间尿动力学时为35.9±5.2（r = 0.9）。这4例患者的膀胱顺应性严重受损。按患者年龄计算，潜在膀胱容量时的顺应性，膀胱测压为6.6±2.1毫升/厘米水柱，夜间尿动力学为9.2±3.4（p = 0.26，r = 0.9）。实际膀胱容量时的顺应性，膀胱测压为3.4±1.2毫升/厘米水柱，夜间尿动力学为3.8±0.8（p = 0.28，r = 0.9）。日间膀胱测压与夜间尿动力学之间存在良好的相关性（p<0.001，Pearson相关系数0.92，95%置信区间0.90至0.94）。kappa统计分析显示，膀胱测压与夜间尿动力学在稳定膀胱和明显逼尿肌不稳定方面具有良好的一致性（kappa = 0.9）。同一观察者对同一患者的重复测量，方差误差为1.7厘米水柱，置信区间较窄，表明测量误差较小，且夜间尿动力学在个体内可相对准确地重复。所有6名儿童都更喜欢夜间尿动力学而非膀胱测压。
膀胱昼夜行为之间存在良好的相关性。夜间尿动力学在预测逼尿肌活动方面准确，对于神经源性膀胱功能障碍的儿童耐受性良好且尴尬程度较低。
