Bruschini Homero, Almeida Fernando G, Srougi Miguel
Division of Urology, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil.
World J Urol. 2006 Jun;24(2):224-8. doi: 10.1007/s00345-006-0087-x. Epub 2006 May 16.
To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively. Detrusor leak point pressure (DLPP) over 40 cm H(2)O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) <or= 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP >or= 40 cm H(2)O and decrease in FBC <or= 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.
评估未经充分泌尿外科治疗的脊髓脊膜膨出患者的上、下尿路情况并修正尿动力学参数。对104例既往未接受充分泌尿外科治疗的脊髓脊膜膨出患者进行了临床、尿动力学和影像学评估。将尿动力学数据与上尿路（UUT）状况相关联。30例患者出现膀胱输尿管反流。6例患者出现无反流的上尿路损伤体征。膀胱测压显示，分别有48%、49%、2%和1%的患者存在逼尿肌过度活动（DO）、顺应性差、膀胱容量增加和膀胱测压正常。逼尿肌漏点压（DLPP）超过40 cm H₂O与上尿路损伤相关。功能性膀胱容量（FBC）减少≤33%的患者比其他患者有更多的肾瘢痕（P = 0.01）。总体而言，未经泌尿外科治疗的脊髓脊膜膨出患者有26%存在肾损伤。DLPP≥40 cm H₂O和FBC减少≤33%与更严重的上尿路损伤相关。DO和顺应性差较为常见，且造成上尿路损伤的风险相似。
