Glassberg Kenneth I, Combs Andrew J
Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, New York NY 10032, USA.
Curr Opin Urol. 2009 Jul;19(4):412-8. doi: 10.1097/MOU.0b013e32832c90d9.
Increased interest in pediatric nonneurogenic voiding disorders (NNVDs), urodynamic testing and therapeutic options make this a timely topic for review.
The major themes covered this year included diagnosis of NNVD by symptomatology and relationship to subsequent urodynamic findings and treatment outcomes; effect of bladder volumes and overdistention, test position, catheter size, catheter in or out during voiding and sex on flow rate, flow pattern, voiding pressures, presence of overactivity and interpretation of findings on both urodynamic studies and uroflow testing; associations between bowel disorders (constipation and encopresis) and NNVD, associations between behavioral disorders and bowel disorders as reflected by treatment response and effect on behavior; efficacy studies on symptom-directed therapies in NNVD, comparison of different biofeedback programs for treating dysfunctional voiding, Botox injections for overactive bladder and an adult anticholinergic for overactive bladder that underwent testing in children; enuresis topics included anticholinergics for treating monosyptomatic enuresis refractory to desmopressin, prevalence of enuresis when screening large numbers of healthy school-age children and its association with certain family characteristics and other bowel and bladder complaints and an update on the association of fluctuation of vasopressin and nightly urine output and its role in patient selection for desmopressin therapy.
While some studies simply validated the past work of others, there were several that dispelled beliefs by demonstrating the inaccuracy of predicting voiding disorders on the basis of uroflow alone or the minimal effect of catheter and test position on urodynamic results; behavior disorders require special care but are not an impediment to successful treatment. Newer therapies, including Botox injections and new or broadened indications for existing anticholinergics, in treating the overactive bladder in children need closer scrutiny.
对小儿非神经源性排尿障碍（NNVDs）、尿动力学检测及治疗选择的兴趣增加，使得这成为一个适合进行综述的热门话题。
今年涵盖的主要主题包括通过症状学诊断NNVD及其与后续尿动力学检查结果和治疗效果的关系；膀胱容量和过度扩张、检查体位、导管尺寸、排尿时导管进出情况以及性别对尿流率、尿流模式、排尿压力、膀胱过度活动症的存在以及尿动力学研究和尿流率检测结果解读的影响；肠道疾病（便秘和大便失禁）与NNVD之间的关联，治疗反应和对行为的影响所反映的行为障碍与肠道疾病之间的关联；NNVD症状导向治疗的疗效研究，不同生物反馈方案治疗功能性排尿障碍的比较，用于治疗膀胱过度活动症的肉毒杆菌毒素注射以及在儿童中进行测试的一种用于膀胱过度活动症的成人抗胆碱能药物；遗尿症主题包括用于治疗对去氨加压素难治的单症状性遗尿症的抗胆碱能药物，筛查大量健康学龄儿童时遗尿症的患病率及其与某些家庭特征以及其他肠道和膀胱症状的关联，以及血管加压素波动与夜间尿量的关联及其在去氨加压素治疗患者选择中的作用的最新进展。
虽然一些研究只是验证了其他研究过去的工作，但也有一些研究通过证明仅根据尿流率预测排尿障碍的不准确或导管和检查体位对尿动力学结果的影响极小来推翻了一些观点；行为障碍需要特别关注，但并非成功治疗的障碍。包括肉毒杆菌毒素注射以及现有抗胆碱能药物新的或扩大的适应症在内的治疗儿童膀胱过度活动症的新疗法需要更仔细的审查。
