Department of Pediatrics, Armed Forces Medical College, 411040, Pune, Maharashtra, India.
Indian J Pediatr. 2010 Dec;77(12):1400-4. doi: 10.1007/s12098-010-0170-6. Epub 2010 Sep 16.
To validate the non-invasive tests that can predict the type of bladder dysfunction normally diagnosed by invasive urodynamics.
Children below 12 yrs of age were evaluated prospectively. Non-invasive urodynamic evaluation included history, clinical examination, frequency volume charting, ultrasonographic scan, urine analysis and renal function tests. Micturating cystourethrogram was carried out in children with recurrent urinary tract infections. All children underwent invasive urodynamic studies and the significance of association of the parameters of noninvasive assessment with invasive urodynamics was determined. Chi square test using Epi 6 software was used for statistical analysis of data.
41 children underwent invasive urodynamic studies. The commonest disorder was detrusor instability in 28 (68.2%). Dysynergic voiding was noted in 8 (19.5%). The study was normal in 5 (12.1%). Nocturnal enuresis with day time symptoms, holding maneuvers, small frequent voiding pattern (p<0.05) and a small capacity bladder with insignificant residue (p=0.0003) predicts detrusor instability. Straining (p=0.0006), large capacity bladder with significant post void residue in the absence of vesicouretric reflux (p<0.05) predicts dysyneric voiding. On combining the various non-invasive tests and validating them against invasive urodynamics in diagnosing detrusor instability and dysnergic voiding, they have a sensitivity of 88.4% and 87.5%, specificity of 72.7% and 69.2%, positive predictive value of 0.88 and 0.63 and positive likelihood ratio of 3.1 & 2.2 respectively.
Functional voiding disorders can be diagnosed with reasonable accuracy by minimally invasive methods.
验证能够预测通常通过侵入性尿动力学诊断的膀胱功能障碍类型的非侵入性测试。
对 12 岁以下的儿童进行前瞻性评估。非侵入性尿动力学评估包括病史、临床检查、频率-容积图表、超声扫描、尿液分析和肾功能检查。在有复发性尿路感染的儿童中进行排尿性膀胱尿道造影。所有儿童均接受了侵入性尿动力学研究，并确定了非侵入性评估参数与侵入性尿动力学的关联意义。使用 Epi 6 软件的卡方检验进行数据分析的统计分析。
41 名儿童接受了侵入性尿动力学研究。最常见的疾病是逼尿肌不稳定，占 28 例（68.2%）。发现协同性排尿困难 8 例（19.5%）。研究正常 5 例（12.1%）。夜间遗尿伴日间症状、持尿动作、小频尿模式（p<0.05）和小容量膀胱伴无意义残余量（p=0.0003）预测逼尿肌不稳定。紧张（p=0.0006）、大容量膀胱伴无膀胱输尿管反流时明显的残余尿（p<0.05）预测协同性排尿困难。在将各种非侵入性测试结合起来，并将其与诊断逼尿肌不稳定和协同性排尿困难的侵入性尿动力学进行验证时，它们的敏感性分别为 88.4%和 87.5%，特异性分别为 72.7%和 69.2%，阳性预测值分别为 0.88 和 0.63，阳性似然比分别为 3.1 和 2.2。
可以通过微创方法准确诊断功能性排尿障碍。
