Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York and Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
J Urol. 2012 Jun;187(6):2188-93. doi: 10.1016/j.juro.2012.01.126. Epub 2012 Apr 12.
Worldwide, uroflowmetry without simultaneous electromyography is often the only testing performed during the initial assessment of children with lower urinary tract symptoms. Various alterations in uroflow pattern are thought to indicate particular types of lower urinary tract conditions, specifically staccato uroflow indicating dysfunctional voiding and intermittent/fractionated uroflow indicating detrusor underactivity. We determined how reliable uroflow pattern alone is as a surrogate for simultaneously measured pelvic floor electromyography activity during voiding, and how well staccato and interrupted uroflow actually correlate with the diagnoses they are presumed to represent.
We reviewed uroflow/electromyography studies performed during the initial evaluation of 388 consecutive neurologically and anatomically normal patients with persistent lower urinary tract symptoms. We identified those with staccato, interrupted/fractionated and mixed uroflow based on current International Children's Continence Society guidelines.
A total of 69 girls (58.5%) and 49 boys (41.5%) met inclusion criteria. Staccato uroflow was noted in 60 patients, interrupted/fractionated uroflow in 28 and a combination in 30. An active electromyography during voiding confirmed the diagnosis of dysfunctional voiding in 33.3% of patients with staccato, 46.4% with interrupted/fractionated and 50% with mixed uroflow patterns.
Diagnoses based on uroflow pattern appearance without simultaneous electromyography to support them can be misleading, and reliance on uroflow pattern alone can lead to overdiagnoses of dysfunctional voiding and detrusor underactivity. When assessing patients with uroflow, an accompanying simultaneous pelvic floor electromyography is of utmost importance for improving diagnostic accuracy and thereby allowing for the most appropriate therapy.
在全球范围内，下尿路症状患儿的初始评估中，通常仅进行尿流率测定而不进行同时的肌电图检查。各种尿流模式的改变被认为可提示特定类型的下尿路疾病，具体而言，顿抑型尿流提示排尿功能障碍，间歇性/部分性尿流提示逼尿肌活动低下。我们旨在确定单纯尿流模式作为同时测量排尿时盆底肌电图活动的替代指标的可靠性，以及顿抑型和间断型尿流实际上与它们所代表的诊断的相关性如何。
我们回顾了 388 例连续的神经系统和解剖结构正常的、持续性下尿路症状患儿的初始评估中的尿流/肌电图研究。我们根据当前的国际儿童尿控协会指南，确定了那些具有顿抑型、间断/部分性和混合性尿流的患者。
共有 69 名女孩（58.5%）和 49 名男孩（41.5%）符合纳入标准。60 例患者存在顿抑型尿流，28 例存在间断/部分性尿流，30 例存在混合性尿流。在 33.3%的顿抑型、46.4%的间断/部分性和 50%的混合性尿流患者中，主动肌电图在排尿时证实了排尿功能障碍的诊断。
不支持诊断的情况下基于尿流模式外观做出的诊断可能具有误导性，单纯依赖尿流模式可能导致排尿功能障碍和逼尿肌活动低下的过度诊断。在评估具有尿流的患者时，伴随的同时盆底肌电图对于提高诊断准确性至关重要，从而可以进行最合适的治疗。
