Kutlu Omer, Koksal Ismail Turker, Guntekin Erol, Kukul Erdal
Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
Scand J Urol Nephrol. 2010 Feb;44(1):32-7. doi: 10.3109/00365590903445223.
The role of spinning top urethra (STU) in children with dysfunctional voiding was evaluated retrospectively.
From 1995 to 2002, the records of 154 children with dysfunctional voiding were reviewed retrospectively. Of the children 110 (71%) were girls and 44 (29%) were boys (mean age 8 years, range 4-14). All children were neurologically normal and no exhibited physical signs of occult spinal dysraphism. Patients were divided into two groups according to their width of proximal urethra: group I had STU and the group II had normal urethral width. The groups were compared with each other for gender, voiding symptoms, urinary tract infection (UTI), vesicoureteral reflux (VUR) and urodynamic observations.
There were 84 children (mean age 8.3 +/- 2.2 years, range 4-14) in group I and 70 (mean age 8.0 +/- 2.1 years, range 4-14) in group II; no significant age difference was found between the two groups (p = 0.4674). Group I consisted of 66 (71%) girls and 18 (29%) boys and group II 44 (63%) girls and 26 (37%) boys. STU was observed more in girls than boys in group I (p = 0.0316). UTI was observed in 57 patients (68%) in group I and 34 (49%) in group II (p = 0.0154). Mean duration of symptoms was 42 +/- 24 months (range 6-118) and 39 +/- 23 (range 3-120) months in groups I and II, respectively (p = 0.6302). Postvoid residual urine (PVR) more than 10% of expected bladder capacity was detected in 15 patients (18%) in group I and seven (10%) in group II. No association was found between the meaningful PVR and STU (p = 0.1653). The presence of detrusor overactivity during filling was observed in 54 patients (64%) in group I and 42 (60%) in group II (p = 0.4676). Diminished bladder compliance (< 10 ml/cmH(2)O) was detected in 34 patients (40%) in group I and 17 (24%) in group II (p = 0.0335). The mean voiding pressure was measured as 56 +/- 29 cmH(2)O in group I, which was significantly higher than in group II (49 +/- 25 cmH(2)O) (p = 0.0373). The mean flow rate during the emptying phase of urodynamics was 16 +/- 8 and 15 +/- 6 ml/s in groups I and II, respectively (not significant, p = 0.2686). VUR was detected in 16 patients (19%) in group I and two (3%) in group II (p = 0.0018).
STU was related to recurrent UTIs, VUR, poor bladder compliance and more serious functional urinary obstruction. Furthermore, STU may be a consequence of a neurogenic maturation defect in detrusor-sphincter coordination resembling that of urofacial syndrome, because development of this situation was found to be independent of the duration of symptoms.
回顾性评估陀螺状尿道（STU）在排尿功能障碍儿童中的作用。
回顾性分析1995年至2002年154例排尿功能障碍儿童的病历。其中110例（71%）为女孩，44例（29%）为男孩（平均年龄8岁，范围4 - 14岁）。所有儿童神经功能正常，未表现出隐性脊柱裂的体征。根据近端尿道宽度将患者分为两组：I组有STU，II组尿道宽度正常。比较两组在性别、排尿症状、尿路感染（UTI）、膀胱输尿管反流（VUR）和尿动力学观察方面的差异。
I组有84例儿童（平均年龄8.3±2.2岁，范围4 - 14岁），II组有70例（平均年龄8.0±2.1岁，范围4 - 14岁）；两组之间未发现显著年龄差异（p = 0.4674）。I组由66例（71%）女孩和18例（29%）男孩组成，II组由44例（63%）女孩和26例（37%）男孩组成。I组中女孩的STU发生率高于男孩（p = 0.0316）。I组57例患者（68%）有UTI，II组34例（49%）有UTI（p = 0.0154）。I组和II组症状的平均持续时间分别为42±24个月（范围6 - 118个月）和39±23个月（范围3 - 120个月）（p = 0.6302）。I组15例患者（18%）检测到残余尿量（PVR）超过预期膀胱容量的10%，II组7例（10%）有此情况。未发现有意义的PVR与STU之间存在关联（p = 0.1653）。I组54例患者（64%）在充盈期观察到逼尿肌过度活动，II组42例（60%）有此情况（p = 0.4676）。I组34例患者（40%）检测到膀胱顺应性降低（<10 ml/cmH₂O），II组17例（24%）有此情况（p = 0.0335）。I组平均排尿压力测量为56±29 cmH₂O，显著高于II组（49±25 cmH₂O）（p = 0.0373）。尿动力学排空期的平均流速在I组和II组分别为16±8和15±6 ml/s（无显著差异，p = 0.2686）。I组16例患者（19%）检测到VUR，II组2例（3%）有VUR（p = 0.0018）。
STU与复发性UTI、VUR、膀胱顺应性差及更严重的功能性尿路梗阻有关。此外，STU可能是逼尿肌 - 括约肌协调的神经源性成熟缺陷的结果，类似于面泌尿综合征，因为发现这种情况的发展与症状持续时间无关。
