Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York 10032, USA.
J Urol. 2013 Jun;189(6):2282-6. doi: 10.1016/j.juro.2013.01.011. Epub 2013 Jan 9.
Noninvasive uroflow with simultaneous electromyography can measure electromyographic lag time, ie the interval between the start of pelvic floor relaxation and the start of urine flow (normally 2 to 6 seconds). Intuitively one would expect that in patients experiencing urgency secondary to detrusor overactivity the lag time would be short or even a negative value. We studied whether short electromyographic lag time on uroflow with electromyography actually correlates with documented detrusor overactivity on urodynamics.
We reviewed 2 separate and distinct cohorts of 50 neurologically and anatomically normal children with persistent lower urinary tract symptoms who were evaluated by uroflow with simultaneous electromyography and videourodynamics. Group 1 consisted of 30 boys and 20 girls (mean age 7.8 years, range 4 to 19) selected based on electromyographic lag time of 0 seconds or less on screening uroflow with electromyography who subsequently underwent videourodynamics. Group 2 consisted of 14 boys and 36 girls (median age 8.4 years, range 5 to 18) selected based on the presence of detrusor overactivity on videourodynamics whose screening uroflow with electromyography was then reviewed. Correlations between short electromyographic lag time and videourodynamically proved detrusor overactivity were analyzed.
For group 1 urodynamics confirmed the presence of detrusor overactivity in all patients with an electromyographic lag time of 0 seconds or less. For group 2 mean ± SD electromyographic lag time was 0.1 ± 1.7 seconds, and 35 patients (70%) with urodynamically proved detrusor overactivity had a lag time of 0 seconds or less.
In patients with lower urinary tract symptoms an electromyographic lag time of 0 seconds or less is 100% predictive of detrusor overactivity. This short electromyographic lag time has 100% specificity and 70% sensitivity for diagnosing detrusor overactivity (88% if less than 2 seconds). Thus, diagnosing the presence or absence of detrusor overactivity in most children with lower urinary tract symptoms and a quiet pelvic floor during voiding can be done reliably via uroflow with simultaneous electromyography.
同时进行肌电图的非侵入性尿流动力学检查可以测量肌电图潜伏期，即盆底放松开始与尿流开始之间的时间间隔（通常为 2 至 6 秒）。直观地说，人们会期望在因逼尿肌过度活动而出现紧迫性的患者中，潜伏期会很短甚至为负值。我们研究了肌电图尿流动力学检查中肌电图潜伏期较短是否与尿动力学检查中逼尿肌过度活动的实际记录相关。
我们回顾了 2 组独立且不同的 50 例具有持续性下尿路症状的神经和解剖学正常的儿童，他们通过肌电图同步尿流动力学检查和视频尿动力学检查进行了评估。第 1 组由 30 名男孩和 20 名女孩组成（平均年龄 7.8 岁，范围 4 至 19 岁），根据筛查性肌电图尿流动力学检查中肌电图潜伏期为 0 秒或更短而选择，随后进行了视频尿动力学检查。第 2 组由 14 名男孩和 36 名女孩组成（中位年龄 8.4 岁，范围 5 至 18 岁），根据视频尿动力学检查中逼尿肌过度活动的存在选择，然后对其进行了筛查性肌电图尿流动力学检查。分析了短肌电图潜伏期与视频尿动力学证实的逼尿肌过度活动之间的相关性。
第 1 组中，所有肌电图潜伏期为 0 秒或更短的患者的尿动力学检查均证实存在逼尿肌过度活动。对于第 2 组，平均±SD 肌电图潜伏期为 0.1±1.7 秒，35 例（70%）存在逼尿肌过度活动的患者肌电图潜伏期为 0 秒或更短。
在具有下尿路症状的患者中，肌电图潜伏期为 0 秒或更短的患者 100%存在逼尿肌过度活动。这种短潜伏期肌电图对逼尿肌过度活动的特异性为 100%，敏感性为 70%（如果小于 2 秒则为 88%）。因此，对于大多数具有下尿路症状且在排尿期间盆底安静的儿童，可以通过肌电图同步尿流动力学检查可靠地诊断逼尿肌过度活动的存在或不存在。
