Apostolos Malioris, Georgios Dimitriadis, Spyridon Kampantais, Georgios Gkotsos, Ioannis Vakalopoulos, Stavros Ioannidis, Konstantinos Hatzimoutatidis, Dimitrios Hatzichristou
1st Department of Urology, "Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Urology, University Hospital of South Manchester, Manchester, UK.
Int Neurourol J. 2015 Dec;19(4):265-71. doi: 10.5213/inj.2015.19.4.265. Epub 2015 Dec 28.
The aim of the present study was to determine the diagnostic accuracy of conventional and ambulatory urodynamic studies (UDS) in estimating neobladder function.
We evaluated 32 patients who underwent radical cystectomy and orthotopic Hautmann W neobladder with Abol-Enein-Ghoneim uretero-intestinal anastomosis for bladder cancer. The patients were initially examined by using both conventional and ambulatory UDS.
Conventional UDS detected a very high mean intravesical pressure at maximum capacity (53.7±17.5 cm H2O). By contrast, the mean intravesical pressure detected by using ambulatory UDS (which reflects the dominant pattern of pressure variation during filling) was significantly lower (34.4±5.2 cm H2O, P<0.001). The comparison between intravesical pressure at half of maximum capacity in conventional UDS and the mean value in ambulatory UDS did not show significant difference (P=0.152). The mean voided volume in conventional UDS was greater than both the mean voided volume (P<0.001) and the mean maximum voided volume in ambulatory UDS (P=0.001). However, this difference did not affect the postvoid residual urine volume measured in both studies (P=0.207). Moreover, incontinence episodes recorded in ambulatory UDS were more frequent but not statistically significantly different from those recorded in conventional UDS (P=0.332).
The estimation of neobladder function by means of ambulatory UDS seems to provide interesting research data for the mode of lower urinary tract function in patients with orthotopic substitution after radical cystectomy. The great high value in ambulatory UDS, in cases in which conventional UDS had failed, is due to the exposure of daily and nocturnal incontinence episodes, confirming our patients' complaints.
本研究旨在确定传统尿动力学检查和动态尿动力学检查（UDS）在评估新膀胱功能方面的诊断准确性。
我们评估了32例因膀胱癌接受根治性膀胱切除术及原位 Hautmann W 新膀胱和 Abol-Enein-Ghoneim 输尿管肠吻合术的患者。患者最初同时接受传统和动态UDS检查。
传统UDS在最大容量时检测到非常高的平均膀胱内压（53.7±17.5 cm H₂O）。相比之下，动态UDS检测到的平均膀胱内压（反映充盈期间压力变化的主要模式）显著更低（34.4±5.2 cm H₂O，P<0.001）。传统UDS最大容量一半时的膀胱内压与动态UDS平均值之间的比较未显示出显著差异（P=0.152）。传统UDS的平均排尿量大于动态UDS的平均排尿量（P<0.001）和平均最大排尿量（P=0.001）。然而，这种差异并未影响两项研究中测量的排尿后残余尿量（P=0.207）。此外，动态UDS记录的尿失禁发作更频繁，但与传统UDS记录的发作相比无统计学显著差异（P=0.332）。
通过动态UDS评估新膀胱功能似乎为根治性膀胱切除术后原位替代患者的下尿路功能模式提供了有趣的研究数据。在传统UDS失败的情况下，动态UDS具有很高的价值，这是由于发现了日常和夜间的尿失禁发作，证实了我们患者的主诉。
