Orlin Jan Roar, Klevmark Bjørn, Bjørnsen Linda, Hermansen Petter, Sanchez Manuel
Department of Orthopaedics, Central Hospital (FSS), Førde, Norway.
Scand J Urol Nephrol. 2010 Mar;44(2):106-12. doi: 10.3109/00365590903544223.
A study of the prevalence of urinary voiding dysfunction was carried out preoperatively in 209 patients undergoing lumbar spine operations, using two non-invasive screening tests: free uroflowmetry and ultrasound measurement of residual urine. The value of using the two urodynamic screening tests in the evaluation of a larger group of patients with sciatica from disc lesions or spinal stenosis has not been published as an article before.
In 209 consecutive patients, 159 with lumbar disc lesions and 50 with lumbar spinal stenosis, the main indications for operative treatment were pain and/or somatic paresis. In preoperative interviews, information about voiding, anal and sexual functions were obtained. Then uroflowmetry was performed and the volume of residual urine was measured. In this study, the definition of normal bladder function is based on normal flow rates, the shape of the curves, normal voided volumes and the absence of significant residual urine. Bladder dysfunction differs from normal function by one, two, three or all four of these parameters.
Normal bladder function was found in 66 patients (31.6%). The other 143 (68.4%) had signs that could indicate sensory paresis and/or neurogenic detrusor underactivity. Seventy-nine of the 143 were also tested 3 months postoperatively. In 58% the bladder function had improved.
The very high prevalence of abnormal uroflowmetry and/or postvoiding residual urine suggestive of possible bladder dysfunction (68.4%) indicates that the two tests should be used routinely in cases of lumbar disc lesions and spinal stenosis. The two tests provide documentation of preoperative voiding function and a possibility of comparison with postoperative findings.
对209例接受腰椎手术的患者进行术前排尿功能障碍患病率研究，采用两项非侵入性筛查试验：自由尿流率测定和残余尿量超声测量。此前尚未有文章发表关于使用这两项尿动力学筛查试验评估更多因椎间盘病变或椎管狭窄导致坐骨神经痛患者的价值。
连续纳入209例患者，其中159例患有腰椎间盘病变，50例患有腰椎管狭窄，手术治疗的主要指征为疼痛和/或躯体麻痹。在术前访谈中，获取有关排尿、肛门及性功能的信息。然后进行尿流率测定并测量残余尿量。本研究中，正常膀胱功能的定义基于正常流速、曲线形状、正常排尿量以及无明显残余尿量。膀胱功能障碍在这些参数中的一项、两项、三项或全部四项与正常功能不同。
66例患者（31.6%）膀胱功能正常。其他143例（68.4%）有提示感觉麻痹和/或神经源性逼尿肌活动低下的体征。143例中的79例在术后3个月也进行了检测。其中58%的患者膀胱功能有所改善。
尿流率异常和/或排尿后残余尿提示可能存在膀胱功能障碍的患病率非常高（68.4%），这表明在腰椎间盘病变和椎管狭窄病例中应常规使用这两项试验。这两项试验提供了术前排尿功能的记录，并有可能与术后结果进行比较。
