Uluocak Nihat, Oktar Tayfun, Acar Omer, Incesu Olga, Ziylan Orhan, Erkorkmaz Unal
Department of Urology, Gaziosmanpasa University School of Medicine, Merkez/Tokat, Turkey.
Urology. 2008 Sep;72(3):530-4; discussion 534-5. doi: 10.1016/j.urology.2008.02.067. Epub 2008 May 27.
To investigate the effect of certain positions on voiding dynamics in children with non-neurogenic bladder dysfunction.
A total of 29 patients (10 male, 19 female) with non-neurogenic overactive bladder were enrolled. None of the patients had voiding phase dysfunction. Male patients were told to urinate in three positions (sitting, squatting, standing). Female patients did not void while standing. During voiding, maximum urinary flow rate (Qmax), detrusor pressure at maximal flow (Pdet-Qmax), and intra-abdominal pressure at maximal flow (Pabd-Qmax) were recorded. After voiding in one position, the bladder was re-distended. The same procedures were repeated for the three different positions. Then patients were told to perform three drinking-voiding cycles without the catheter in place. After recording Qmax, residual urine was measured with ultrasonography. The differences between these parameters were analyzed.
The mean (+/- standard deviation) patient age was 11.10 +/- 2.94 years (range, 6-16 years). In girls, the mean Pdet-Qmax value in the sitting and squatting positions was 43.11 +/- 16.74 cm H(2)O and 35.21 +/- 10.67 cm H(2)O, respectively (P = .028). Girls voided with a significantly higher Qmax in sitting and squatting positions than boys, regardless of the presence of a catheter. The mean Pdet-Qmax value in the squatting position was 59.20 +/- 20.45 cm H(2)O in boys and 35.21 +/- 10.67 cm H(2)O in girls. The presence of a catheter significantly lowered mean maximal urinary flow rates in sitting and squatting positions.
This is the first study to demonstrate the effect of voiding positions on pressure flow study results in children. Our results show that voiding dynamics are influenced by different voiding positions in children with non-neurogenic bladder dysfunction.
研究特定体位对非神经源性膀胱功能障碍患儿排尿动力学的影响。
共纳入29例非神经源性膀胱过度活动症患者（10例男性，19例女性）。所有患者均无排尿期功能障碍。男性患者被要求在三个体位（坐位、蹲位、站位）排尿。女性患者不在站位排尿。排尿过程中，记录最大尿流率（Qmax）、最大尿流时逼尿肌压力（Pdet-Qmax）和最大尿流时腹内压（Pabd-Qmax）。在一个体位排尿后，膀胱重新充盈。对三个不同体位重复相同操作。然后让患者在无导尿管情况下进行三个饮水-排尿周期。记录Qmax后，用超声测量残余尿量。分析这些参数之间的差异。
患者平均年龄为11.10±2.94岁（范围6-16岁）。在女孩中，坐位和蹲位时的平均Pdet-Qmax值分别为43.11±16.74 cm H₂O和35.21±10.67 cm H₂O（P = 0.028）。无论是否留置导尿管，女孩在坐位和蹲位时排尿的Qmax均显著高于男孩。男孩蹲位时的平均Pdet-Qmax值为59.20±20.45 cm H₂O，女孩为35.21±10.67 cm H₂O。留置导尿管显著降低了坐位和蹲位时的平均最大尿流率。
这是第一项证明排尿体位对儿童压力流率研究结果有影响的研究。我们的结果表明，非神经源性膀胱功能障碍患儿的排尿动力学受不同排尿体位的影响。
