Kon Masafumi, Mitsui Takahiko, Kitta Takeya, Moriya Kimihiko, Shinohara Nobuo, Takeda Masayuki, Nonomura Katsuya
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Japan.
Department of Urology, University of Yamanashi Graduate School of Medical Science, 1110 Simokato, Chuo-City, Yamanashi, 409-3898, Japan.
Int Urol Nephrol. 2018 Feb;50(2):211-215. doi: 10.1007/s11255-017-1770-0. Epub 2017 Dec 14.
We measured posterior urethra diameter (PUD) and external urethral sphincter diameter (EUSD), which can also be measured by voiding cystourethrography (VCUG) and investigated the relationship between PUD/EUSD and detrusor pressure (Pdet) during voiding by videourodynamics (VUDS).
Sixty-three children, who were 3 years old or less and underwent VUDS, were enrolled in the present study. We measured PUD and EUSD in addition to detrusor pressure at the time of the widest EUS during voiding (Pdet-voiding) by VUDS, and PUD/EUSD was investigated compared to Pdet-voiding.
Seventy-eight VUDS were performed in 63 patients, and the median age at VUDS was 10.2 months. These studies revealed a significant correlation between PUD/EUSD and Pdet-voiding (r = 0.641, p < 0.001). However, a significant correlation was not observed between PUD/EUSD and age (r = 0.180). We defined Pdet-voiding of more than 80 cmHO as a high voiding pressure, and a PUD/EUSD of 2.4 was a good predictor for the cutoff value for high voiding pressure. Pdet-voiding was significantly higher in children with a PUD/EUSD of ≥ 2.4 (p < 0.001). In 19 children who had neurological diseases, a significant correlation was found between PUD/EUSD and Pdet-voiding (r = 0.842, p < 0.001), and a PUD/EUSD of 2.4 was a useful cutoff value for high voiding pressure.
PUD/EUSD is a valuable tool to predict high voiding pressure in pediatric patients. A PUD/EUSD of ≥ 2.4 in VCUG indicates the need to perform more invasive tests, such as VUDS, in pediatric patients aged 3 and under with neuropathic diseases.
我们测量了后尿道直径（PUD）和尿道外括约肌直径（EUSD），这两者也可通过排尿性膀胱尿道造影（VCUG）进行测量，并通过影像尿动力学（VUDS）研究了排尿期间PUD/EUSD与逼尿肌压力（Pdet）之间的关系。
本研究纳入了63名3岁及以下接受VUDS检查的儿童。我们通过VUDS测量了排尿时尿道外括约肌最宽处的逼尿肌压力（Pdet-排尿），此外还测量了PUD和EUSD，并将PUD/EUSD与Pdet-排尿进行比较研究。
63例患者共进行了78次VUDS检查，VUDS检查时的中位年龄为10.2个月。这些研究显示PUD/EUSD与Pdet-排尿之间存在显著相关性（r = 0.641，p < 0.001）。然而，未观察到PUD/EUSD与年龄之间存在显著相关性（r = 0.180）。我们将Pdet-排尿超过80 cmH₂O定义为高排尿压力，PUD/EUSD为2.4是高排尿压力临界值的良好预测指标。PUD/EUSD≥2.4的儿童Pdet-排尿显著更高（p < 0.001）。在19例患有神经疾病的儿童中，发现PUD/EUSD与Pdet-排尿之间存在显著相关性（r = 0.842，p < 0.001），PUD/EUSD为2.4是高排尿压力的有用临界值。
PUD/EUSD是预测儿科患者高排尿压力的有价值工具。VCUG中PUD/EUSD≥2.4表明3岁及以下患有神经性疾病的儿科患者需要进行更具侵入性的检查，如VUDS。
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