JU Yan-he, LIAO Li-min, LI Dong, FU Guang, LIANG Wen-li, XIONG Zong-sheng, WU Juan, SHI Wen-bo, HAN Chun-sheng
Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing 100068, China.
Zhonghua Wai Ke Za Zhi. 2008 Oct 15;46(20):1525-8.
To explore the Video-urodynamic characteristics of various neurogenic bladder.
A total of 1800 patients with neurogenic bladder were included in our study from December 2002 to June 2008. All patients underwent Video-urodynamic studies. Urodynamic data was collected and analyzed.
Urodynamic study showed detrusor overactivity in 71%, of which 60% with uninhibited sphincter relaxation, and acontractile detrusor in 29% stroke patients. No upper urinary tract deterioration was found in all 42 stroke patients. Detrusor overactivity without sphincter dyssynergia was found in 70% patients with head trauma. Seven patients with Parkinson disease showed detrusor overactivity, of which 3 with delayed sphincter relaxation. Detrusor overactivity was found in 91% and detrusor sphincter dyssynergia in 83% supra-sacral spinal cord injured patients. Acontractile detrusor was found in 73% patients with conus medullaris and cauda equina injury. Overall, upper urinary tract changes were found in 12% and vesicoureteral reflux in 4% spinal cord injured patients. Urodynamic study showed acontractile detrusor in 81%, reduced compliance in 86%, upper urinary tract changes in 55% and vesicoureteral reflux in 33% patients with myelodysplasia. Most patients (92%) with protruded lumbar disc showed detrusor areflexia. Normal bladder compliance was found in 88% patients with protruded lumbar disc. Urodynamic study showed reduced bladder sensation in 81% and detrusor under-activity in 76% patients with diabetic urinary bladder disease.
Video-urodynamic study can provide the most detailed information about the bladder dysfunction. It is the most valuable examination before treatment of patients with neurogenic bladder.
探讨各种神经源性膀胱的影像尿动力学特征。
2002年12月至2008年6月,共有1800例神经源性膀胱患者纳入本研究。所有患者均接受影像尿动力学检查。收集并分析尿动力学数据。
尿动力学研究显示,71%的患者存在逼尿肌过度活动,其中60%伴有括约肌无抑制性松弛,29%的中风患者存在逼尿肌收缩无力。42例中风患者均未发现上尿路恶化。70%的头部外伤患者存在无括约肌协同失调的逼尿肌过度活动。7例帕金森病患者表现为逼尿肌过度活动,其中3例伴有括约肌松弛延迟。91%的骶上脊髓损伤患者存在逼尿肌过度活动,83%存在逼尿肌括约肌协同失调。73%的圆锥和马尾神经损伤患者存在逼尿肌收缩无力。总体而言,12%的脊髓损伤患者出现上尿路改变,4%出现膀胱输尿管反流。尿动力学研究显示,81%的脊髓发育不良患者存在逼尿肌收缩无力,86%的患者顺应性降低,55%的患者出现上尿路改变,33%的患者出现膀胱输尿管反流。大多数腰椎间盘突出症患者(92%)表现为逼尿肌无反射。88%的腰椎间盘突出症患者膀胱顺应性正常。尿动力学研究显示,81%的糖尿病膀胱病患者膀胱感觉减退,76%的患者逼尿肌活动不足。
影像尿动力学研究可为膀胱功能障碍提供最详细的信息。它是神经源性膀胱患者治疗前最有价值的检查。