Naghizadeh Sohrab, Kefi Aykut, Dogan Hasan Serkan, Burgu Berk, Akdogan Bulent, Tekgul Serdar
Faculty of Medicine, Department of Urology, Hacettepe University, Sihhiye, 06100 Ankara, Turkey.
Eur Urol. 2005 Nov;48(5):819-25. doi: 10.1016/j.eururo.2005.05.019. Epub 2005 Jun 22.
The present study aims to evaluate the effect of desmopressin treatment on urine output, density and glomerular filtration rate (GFR) in patients with posterior urethral valve (PUV) and the factors affecting the response to this treatment.
A total of 68 PUV patients who were followed-up after valve ablation were examined with the fluid intake, urine output and GFR. Sixteen patients who were polyuric (a urine output more than 30 ml/kg/day) and had hypoosmolar urine (urinary density of 1015 or lower) included in the study. Blood chemistry and serum ADH level were studied. Following 5 days of observation, patients were given DDAVP perorally with a dosage of 0.4 mg/day, two equal doses per day. After 7 days and after a 3 month period of treatment, voiding characteristics, day-time and night-time urine densities and also GFR have been re-evaluated.
The mean age was 6.8 years (range 2 to 11 years). The mean age at valve ablation was 20.7 months (range 5 months to 6 years). The mean daily urine output during first week and at the third month of the treatment had decreased significantly (p=0.004 and p=0.006). There was increase in night-time and day-time urine density in 10 patients (62%) and in 13 patients (81%) respectively at the third month evaluation. Increments in urine density were statistically significant for the third month evaluation. Nine (56%) patients had ADH levels within normal (<7 pcg/ml) levels and 7 patients had higher levels. There was no statistically significant difference between pretreatment and posttreatment micturation characteristics. However patients with voiding dysfunction responded better to DDAVP treatment.
Desmopressin treatment improves polyuria in PUV patients. The responses are better particularly in PUV patients with significant bladder dysfunction. This supports the harmful role of polyuria on bladder dysfunction. The DDAVP treatment improves the day-time and night-time in PUV patients. Combination of DDAVP treatment with overnight catheterization may be a good alternative that needs to be evaluated by further prospective randomized studies.
本研究旨在评估去氨加压素治疗对后尿道瓣膜（PUV）患者尿量、尿比重及肾小球滤过率（GFR）的影响，以及影响该治疗反应的因素。
对68例瓣膜切除术后接受随访的PUV患者进行液体摄入量、尿量及GFR检查。16例多尿（尿量超过30 ml/kg/天）且尿渗透压减低（尿比重为1.015或更低）的患者纳入研究。研究血液生化指标及血清抗利尿激素（ADH）水平。观察5天后，患者口服去氨加压素，剂量为0.4 mg/天，分两次等量给药。治疗7天后及治疗3个月后，重新评估排尿特征、日间及夜间尿比重以及GFR。
平均年龄为6.8岁（范围2至11岁）。瓣膜切除时的平均年龄为20.7个月（范围5个月至6岁）。治疗第一周及第三个月时的平均每日尿量显著减少（p = 0.004及p = 0.006）。在第三个月评估时，分别有10例患者（62%）夜间尿比重增加，13例患者（81%）日间尿比重增加。第三个月评估时尿比重的增加具有统计学意义。9例（56%）患者的ADH水平在正常范围内（<7 pg/ml），7例患者的ADH水平较高。治疗前与治疗后排尿特征无统计学显著差异。然而，存在排尿功能障碍的患者对去氨加压素治疗反应更好。
去氨加压素治疗可改善PUV患者的多尿症状。特别是在膀胱功能严重障碍的PUV患者中反应更佳。这支持了多尿对膀胱功能障碍的有害作用。去氨加压素治疗可改善PUV患者的日间及夜间排尿情况。去氨加压素治疗与夜间导尿相结合可能是一种良好的选择，有待进一步前瞻性随机研究评估。
