原发性夜间遗尿持续至成年期，功能评估。

Mansoura Urology & Nephrology Center, Mansoura, Egypt.

Neurourol Urodyn. 2004;23(1):54-7. doi: 10.1002/nau.10161.

INTRODUCTION AND OBJECTIVES

The incidence of nocturnal enuresis (NE) in adults (over 18 years of age) ranges from 0.5 to 2% for most authors. NE is a multifactorial disease. Lack of circadian rhythm of antidiuretic hormone (ADH) is one of the commonly accepted causes, however, disorders affecting bladder function is another important pathophysiologic factor that has not been settled. The target of the present study is to define bladder function in adults having persistent NE.

METHODS

Fifty two adult patients were included. Mean age was 23.6 +/- 6.9 years. All of them had primary NE persistent to adulthood. No treatment was received within 2-7 days prior to the urodynamic examination. All of them had intact neuro-urological examination. Filling (in all patients) and voiding cystometry (in 29 patients) were carried out, using 8 F urodynamic and 8 F rectal catheters. Pressure flow analysis was interpreted using Schafer's nomogram.

RESULTS

Overall mean maximum cystometric capacity was 419.2 +/- 142 ml, mean bladder compliance was 51.3 +/- 39.7 ml/cmH2O. In males (n=25), mean maximum cystometric capacity was 453 +/- 173 ml and compliance was 56 +/- 42 ml/cmH2O, while in females (n=27), mean capacity was 388 +/- 98 ml and compliance was 46.7 +/- 36.7 ml/cmH2O. Twenty patients had detrusor instability (38.5%). Twelve out of 27 (44.4%) females had instability while only 8 out of 25 (32%) males had the same finding. Differences relevant to maximum bladder capacity and compliance between the patients with and without instability were significant (P<0.0001). Mean detrusor opening pressure was 55.3 +/- 25 cmH2O, mean detrusor pressure at maximum flow and maximum detrusor pressure, were 53.5 +/- 21 and 78.9 +/- 35 cmH2O respectively.

CONCLUSIONS

Urodynamic studies in adults with persistent NE reveals a relatively high incidence of instability, normal capacity and compliance. The presence of instability was associated with smaller bladder and poorer compliance and with diurnal urgency. Voiding bladder function in adult enuretics was found to be normal.

引言与目的

多数作者认为，成人（18岁以上）夜间遗尿（NE）的发病率在0.5%至2%之间。NE是一种多因素疾病。抗利尿激素（ADH）昼夜节律缺失是普遍认可的病因之一，然而，影响膀胱功能的紊乱是另一个尚未明确的重要病理生理因素。本研究的目的是明确持续性NE成年患者的膀胱功能。

方法

纳入52例成年患者。平均年龄为23.6±6.9岁。所有患者原发性NE持续至成年。在进行尿动力学检查前2至7天未接受任何治疗。所有患者神经泌尿检查均正常。使用8F尿动力学导管和8F直肠导管对所有患者进行膀胱充盈测定（全部患者）和排尿膀胱测压（29例患者）。压力流分析采用谢弗列线图进行解读。

结果

总体平均最大膀胱测压容量为419.2±142ml，平均膀胱顺应性为51.3±39.7ml/cmH₂O。男性（n = 25）平均最大膀胱测压容量为453±173ml，顺应性为56±42ml/cmH₂O，而女性（n = 27）平均容量为388±98ml，顺应性为46.7±36.7ml/cmH₂O。20例患者存在逼尿肌不稳定（38.5%）。27例女性中有12例（44.4%）存在不稳定，而25例男性中只有8例（32%）有相同表现。有不稳定和无不稳定患者之间在最大膀胱容量和顺应性方面的差异具有显著性（P<0.0001）。平均逼尿肌开放压力为55.3±25cmH₂O，平均最大尿流率时逼尿肌压力和最大逼尿肌压力分别为53.5±21和78.9±35cmH₂O。