Van Batavia J P, Combs A J, Fast A M, Glassberg K I
Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
J Pediatr Urol. 2014 Jun;10(3):532-7. doi: 10.1016/j.jpurol.2013.11.015. Epub 2013 Dec 17.
Non-invasive uroflowmetry with simultaneous electromyography (uroflow/EMG) has previously been reported as effective in triaging patients into four specific non-neurogenic lower urinary tract (LUT) conditions for targeted treatment. In this study we sought to determine if the same parameters would be useful for measuring response to treatment.
We reviewed our database of normal children with LUT dysfunction, screened with uroflow/EMG, and diagnosed with a LUT condition: (1) dysfunctional voiding (DV); (2) idiopathic detrusor overactivity disorder (IDOD); (3) detrusor underutilization disorder (DUD); (4) primary bladder neck dysfunction (PBND). Pre- and on-treatment (minimum 3 months) uroflow/EMG parameters and subjective improvements were compared.
Of 159 children (71 boys, 88 girls; median age 7.0 years, range 3.5-18.0 years), median follow up was 13.1 months (range 3-43 months). On targeted treatment, DV patients showed relaxation of pelvic floor during voiding and significant decrease in PVR on biofeedback; IDOD patients had normalization of short lag time and increased capacity on antimuscarinics; DUD patients had a decrease in capacity on timed voiding; PBND patients on alpha-blocker therapy showed improved uroflow rates and a decrease in mean EMG lag time (all p < 0.05).
Non-invasive uroflow/EMG is useful not only for diagnosing specific LUT conditions, but also in objectively monitoring treatment efficacy. Subjective improvement on targeted therapy correlates well with objective improvements in uroflow/EMG parameters lending validation to this simplified approach to diagnosis.
先前有报道称，同步肌电图的无创尿流率测定法（尿流率/肌电图）可有效地将患者分类为四种特定的非神经源性下尿路（LUT）疾病，以便进行针对性治疗。在本研究中，我们试图确定相同的参数是否有助于衡量治疗反应。
我们回顾了经尿流率/肌电图筛查并诊断为LUT疾病的正常LUT功能障碍儿童数据库：（1）排尿功能障碍（DV）；（2）特发性逼尿肌过度活动症（IDOD）；（3）逼尿肌利用不足症（DUD）；（4）原发性膀胱颈功能障碍（PBND）。比较治疗前和治疗时（至少3个月）的尿流率/肌电图参数及主观改善情况。
159名儿童（71名男孩，88名女孩；中位年龄7.0岁，范围3.5 - 18.0岁），中位随访时间为13.1个月（范围3 - 43个月）。在针对性治疗中，DV患者排尿时盆底松弛，生物反馈治疗后残余尿量显著减少；IDOD患者使用抗毒蕈碱药物后短延迟时间恢复正常，膀胱容量增加；DUD患者定时排尿时膀胱容量减少；接受α受体阻滞剂治疗的PBND患者尿流率提高，平均肌电图延迟时间缩短（所有p < 0.05）。
无创尿流率/肌电图不仅有助于诊断特定的LUT疾病，还能客观监测治疗效果。针对性治疗的主观改善与尿流率/肌电图参数的客观改善密切相关，证实了这种简化诊断方法的有效性。
