Szabó László, Lombay Béla, Borbás Eva, Bajusz Ilona
Department of Nephrology, Child Health Center, Borsod County Teaching Hospital, PO Box 188, Miskolc 3501, Hungary.
Pediatr Nephrol. 2004 Mar;19(3):326-31. doi: 10.1007/s00467-003-1341-8. Epub 2003 Dec 20.
The lower urinary tract is a complicated structure and there has been some controversy regarding the biomechanics and dynamics of bladder and sphincter function. Investigation of the function and morphological anomalies is very important. Videourodynamics (VUD) combined with conventional voiding cystourethrography (VCUG) seems to be the most appropriate method. Over a 12-year study period (January 1990 to December 2001), 422 children (aged 5 days to 20 years) prospectively underwent VUD to further define their urinary tract abnormalities. In all children the history was recorded, clinical examination, urinalysis, culture, and ultrasonography performed, and serum creatinine determined before VUD. The selection criteria included a history of recurrent urinary tract infections (UTI) in 310 patients (74%), urinary tract dilatation without UTI in 31 patients (7%), suspected neurogenic bladder dysfunction in 42 patients (10%), and voiding difficulties in 39 patients (9%). VUD consists of cystometry (CM), which is the measurement of detrusor pressure during controlled bladder filling and subsequent voiding, and was combined with VCUG using X-ray contrast material. CM is used to assess detrusor activity, sensation, capacity, and compliance. CM measurements were recorded on a computer and vesicoureteric reflux (VUR) was documented at the same time with plain films and later in a PACS system. The VUD diagnosis was of normal bladder function in 46 patients (9%), VUR in 212 (43%), unstable bladder dysfunction in 152 (31%), neurogenic bladder dysfunction in 35 (7%), urine outflow obstruction in 15 (3%), wide bladder neck in 22 (4%), and vaginal reflux in 9 (2%). Neurogenic bladder dysfunction was excluded in 7 patients (1%). VUD is useful for the investigation of the lower urinary tract function together with X-ray morphology. The advantage of these studies is that they combine the objectivity of urodynamics with the visual radiographic image, leading to lower radiation doses and a more logical interpretation of the results.
下尿路是一个复杂的结构，关于膀胱和括约肌功能的生物力学及动力学一直存在一些争议。对功能和形态异常的研究非常重要。视频尿动力学（VUD）结合传统的排尿性膀胱尿道造影（VCUG）似乎是最合适的方法。在12年的研究期间（1990年1月至2001年12月），422名儿童（年龄从5天至20岁）前瞻性地接受了VUD检查，以进一步明确他们的尿路异常情况。在所有儿童中，记录病史，进行临床检查、尿液分析、培养及超声检查，并在VUD检查前测定血清肌酐。选择标准包括310例患者（74%）有反复尿路感染（UTI）病史，31例患者（7%）无UTI但有尿路扩张，42例患者（10%）怀疑有神经源性膀胱功能障碍，39例患者（9%）有排尿困难。VUD包括膀胱测压（CM），即在控制膀胱充盈及随后排尿过程中测量逼尿肌压力，并与使用X线造影剂的VCUG相结合。CM用于评估逼尿肌活动、感觉、容量及顺应性。CM测量结果记录在计算机上，同时通过平片记录膀胱输尿管反流（VUR），随后在PACS系统中记录。VUD诊断结果为46例患者（9%）膀胱功能正常，212例患者（43%）有VUR，152例患者（31%）有不稳定膀胱功能障碍，35例患者（7%）有神经源性膀胱功能障碍，15例患者（3%）有尿流梗阻，22例患者（4%）有宽膀胱颈，9例患者（2%）有阴道反流。7例患者（1%）排除神经源性膀胱功能障碍。VUD对于结合X线形态学研究下尿路功能很有用。这些研究的优点是将尿动力学的客观性与影像学视觉图像相结合，从而降低辐射剂量并使结果的解释更合理。
