Section of Voiding Dysfunction and Urodynamics, Urology Department, Faculty of Medicine, Alexandria University, Azarita, 21113 Alexandria, Egypt.
J Pediatr Urol. 2013 Jun;9(3):348-52. doi: 10.1016/j.jpurol.2012.04.015. Epub 2012 Jun 7.
After failure of medical and behavioral therapy in enuresis, the usual next step is to investigate using urodynamics. The aim of this study was to determine the actual benefit and optimal method of urodynamics in the treatment of refractory enuresis.
This prospective randomized study included 56 patients: 17 males and 39 females with an age range of 7-16 years. All had tried multiple courses of medical treatment for enuresis for at least 6 months without response. Thirty patients underwent investigation by cystometrogram, uroflowmetry and electromyogram (UFM/EMG), while 26 patients underwent pressure/flow/EMG (P/F/EMG) studies.
Bladder filling abnormalities were found in 25 out of the 56 patients (44.6%) and included low bladder capacity in 39%, hypocompliance in 32%, and detrusor overactivity in 45%. With regard to voiding dysfunction, 70% of the UFM/EMG group had detrusor‒sphincter dyssynergia and 67% of the P/F/EMG group had bladder outlet obstruction.
Urodynamics can help in cases of refractory enuresis by detecting dysfunctional voiding, which is present in a large percentage of these patients. This can be diagnosed by UFM/EMG, rather than P/F/EMG, as a non-invasive test. UFM alone may be misleading. Alpha adrenergic blockers may be of benefit in treating these patients.
在遗尿症的药物和行为治疗失败后，通常下一步是进行尿动力学检查。本研究旨在确定尿动力学在治疗难治性遗尿症中的实际获益和最佳方法。
这是一项前瞻性随机研究，共纳入 56 例患者：17 例男性，39 例女性，年龄 7-16 岁。所有患者均尝试过多次针对遗尿症的药物治疗，但至少 6 个月无反应。30 例患者接受了膀胱测压、尿流率和肌电图（UFM/EMG）检查，26 例患者接受了压力/流量/肌电图（P/F/EMG）检查。
56 例患者中，25 例（44.6%）存在膀胱充盈异常，包括膀胱容量低（39%）、顺应性降低（32%）和逼尿肌过度活动（45%）。在排尿功能障碍方面，UFM/EMG 组 70%存在逼尿肌-括约肌协同失调，P/F/EMG 组 67%存在膀胱出口梗阻。
尿动力学检查可以帮助诊断难治性遗尿症患者的排尿功能障碍，这些患者中存在很大比例的排尿功能障碍。UFM/EMG 而非 P/F/EMG 作为一种非侵入性检查可以诊断这种功能障碍。单独的 UFM 可能会产生误导。α肾上腺素能阻滞剂可能对这些患者有益。
