Van Batavia Jason P, Combs Andrew J, Fast Angela M, Glassberg Kenneth I
Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA.
Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA.
J Pediatr Urol. 2017 Jun;13(3):277.e1-277.e4. doi: 10.1016/j.jpurol.2017.02.010. Epub 2017 Mar 10.
The ICCS defines OAB by the subjective symptom of urgency; detrusor overactivity (DO) is only implied. While no other symptom is required, OAB can also be associated with urinary frequency, decreased functional bladder capacity, and incontinence.
We sought to determine how often these associated findings occur in OAB and what if any uroflow/EMG-defined conditions are found to be associated with it.
The charts of 548 children (231M, 318F; mean age 9.0 years, range 3-20) who presented sequentially with urgency (OAB), over a period of 2 years, were reviewed paying particular attention to whether or not there was a history of frequency and/or daytime incontinence in addition to the urgency. All patients had been previously diagnosed with one of the following four lower urinary tract (LUT) conditions based on specific uroflow/EMG findings: 1. dysfunctional voiding (DV; active pelvic floor EMG during voiding); 2. idiopathic detrusor overactivity disorder (IDOD; OAB with a short EMG lag time (<2 s), and quiet pelvic floor EMG during voiding); 3. detrusor underutilization disorder (DUD; willful infrequent voiding with %EBC >125%, quiet EMG during voiding); and 4. primary bladder neck dysfunction (PBND; prolonged EMG lag time (>6 s), quiet EMG during voiding, and depressed uroflow curve). Mean %EBC was compared between patients with urgency alone and those with urgency plus other symptoms. Any association with gender was analyzed.
Urgency was accompanied by either frequency or daytime incontinence in 91% of the children (summary Table). Daytime incontinence was reported in 398 (72.6%) and frequency in 268 (48.9%). Mean %EBC was 80.9. Females were more likely to report daytime incontinence (76.7% vs. 66.7%, p = 0.02) and frequency was found more often in males (63.6% vs. 38.1%, p < 0.001). %EBC was less in males (70.0 vs. 88.8, p < 0.001). The majority of patients with urgency were diagnosed with IDOD (62%), while 15% had DV, 5% PBND, 3% DUD, and in 15%, the uroflow/EMG was not diagnostic.
%EBC was usually normal or mildly increased in OAB when urgency is the only symptom but significantly decreases with each additional LUTS. OAB is more common in girls and they tend to have a lower incidence of frequency, more incontinence, and >%EBC than boys. Because urgency in an anatomically and neurologically normal child is the only required criterion for diagnosing OAB, it must be realized that OAB can be associated with any of a number of objectively defined LUT conditions. Thus OAB appears to be a symptom, not a condition, that is often associated with other symptoms.
国际儿童尿控协会（ICCS）通过尿急这一主观症状来定义膀胱过度活动症（OAB）；仅暗示存在逼尿肌过度活动（DO）。虽然不需要其他症状，但OAB也可能与尿频、功能性膀胱容量减少及尿失禁相关。
我们试图确定这些相关表现在OAB中出现的频率，以及是否发现有任何尿流率/肌电图定义的情况与之相关。
回顾了548例儿童（231例男性，318例女性；平均年龄9.0岁，范围3 - 20岁）的病历，这些儿童在2年时间里陆续出现尿急（OAB）症状，特别关注除尿急外是否有尿频和/或日间尿失禁史。所有患者此前均根据特定的尿流率/肌电图检查结果被诊断为以下四种下尿路（LUT）疾病之一：1. 排尿功能障碍（DV；排尿时盆底肌电图活跃）；2. 特发性逼尿肌过度活动症（IDOD；OAB且肌电图延迟时间短（<2秒），排尿时盆底肌电图平静）；3. 逼尿肌利用不足症（DUD；故意少尿且膀胱排空百分比（%EBC）>125%，排尿时肌电图平静）；4. 原发性膀胱颈功能障碍（PBND；肌电图延迟时间延长（>6秒），排尿时肌电图平静，尿流率曲线低平）。比较了仅有尿急症状的患者与伴有其他症状的患者的平均%EBC。分析了与性别的任何关联。
91%的儿童尿急伴有尿频或日间尿失禁（汇总表）。报告有日间尿失禁的有398例（72.6%），有尿频的有268例（48.9%）。平均%EBC为80.9。女性更易报告日间尿失禁（76.7%对66.7%，p = 0.02），男性尿频更常见（63.6%对38.1%，p < 0.001）。男性的%EBC更低（70.0对88.8，p < 0.001）。大多数尿急患者被诊断为IDOD（62%），而15%患有DV，5%患有PBND，3%患有DUD，15%的尿流率/肌电图检查结果未明确诊断。
当尿急是唯一症状时，OAB患者的%EBC通常正常或轻度升高，但每增加一种下尿路症状（LUTS），%EBC就会显著降低。OAB在女孩中更常见，与男孩相比，她们尿频发生率较低，尿失禁更多，且%EBC更高。由于解剖和神经功能正常的儿童诊断OAB的唯一必要标准是尿急，必须认识到OAB可能与多种客观定义的下尿路疾病中的任何一种相关。因此，OAB似乎是一种症状，而非一种疾病，且常与其他症状相关。
