Liu Ning, He Feng, Wang Hai, Huang Guang-lin, Man Li-bo, Liao Li-min
Department of Urology, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Wai Ke Za Zhi. 2008 Oct 1;46(19):1494-6.
To evaluate the urodynamic characteristics of the chronic impairment of cauda equina caused by lumbar disk herniation.
Clinical data and urodynamic parameters of 67 male patients with lumbar disk herniation were retrospectively analyzed. Lower urinary obstruction was excluded from the cohort using the Lin-PURR analysis. Patients were divided into group A (normal detrusor function), group B (detrusor underactivity) and group C (detrusor areflexia) according to the detrusor contraction function analyzed in Lin-PURR. Clinical data and urodynamic parameters were analyzed statistically between these groups.
The category of the detrusor contraction function had a significant effect on the urodynamic parameters. There were significant differences in the maximum flow rate (Q(max)), maximum pressure (P(max)), pressure at the maximum flow (P(det Qmax)) and post-voiding residual urine (PVR) among group A, B and C. There were significant differences in the first sensation volume of the bladder and the maximum cystometric capacity between group A and C, B and C, but no significance was found between group A and B. There was no significant difference in age, disease duration, and compliance of the bladder among 3 groups.
Urodynamic study is important in exploring the severity of the chronic impairment of cauda equina caused by lumbar disk herniation. Detrusor areflexia and loss of bladder sensory indicate more severe degree of impairment of the cauda equine. Q(max) and PVR are helpful in early diagnosis of the chronic impairment of cauda equina.
评估腰椎间盘突出症所致马尾神经慢性损伤的尿动力学特征。
回顾性分析67例男性腰椎间盘突出症患者的临床资料及尿动力学参数。采用Lin-PURR分析排除队列中的下尿路梗阻患者。根据Lin-PURR分析的逼尿肌收缩功能，将患者分为A组（逼尿肌功能正常）、B组（逼尿肌活动减退）和C组（逼尿肌无反射）。对这些组间的临床资料和尿动力学参数进行统计学分析。
逼尿肌收缩功能类别对尿动力学参数有显著影响。A组、B组和C组之间的最大尿流率（Q(max)）、最大压力（P(max)）、最大尿流时压力（P(det Qmax)）和排尿后残余尿量（PVR）存在显著差异。A组与C组、B组与C组之间膀胱首次感觉容量和最大膀胱测压容量存在显著差异，但A组与B组之间无显著差异。三组之间在年龄、病程和膀胱顺应性方面无显著差异。
尿动力学研究对于探索腰椎间盘突出症所致马尾神经慢性损伤的严重程度具有重要意义。逼尿肌无反射和膀胱感觉丧失表明马尾神经损伤程度更严重。Q(max)和PVR有助于马尾神经慢性损伤的早期诊断。
