Pediatric Urology, Erzurum Training and Research Hospital, Erzurum, Turkey.
Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey.
J Urol. 2021 Feb;205(2):577-585. doi: 10.1097/JU.0000000000001335. Epub 2020 Sep 8.
The International Children's Continence Society recommends urodynamics repeated at least twice for the optimal result. We aimed to search if 3 times repeat filling urodynamics in the same session would change the urodynamics parameters in children with neurogenic lower urinary tract dysfunction due to myelodysplasia.
We investigated urodynamic reports and charts of 80 consecutive children with neurogenic lower urinary tract dysfunction due to myelodysplasia who underwent 3 repeat, same session filling cystometry studies between June 2017 and December 2018. Maximum detrusor pressure, maximum cystometric capacity, detrusor leak point pressure, compliance, residual urine volume and maximum cystometric capacity/estimated bladder capacity for age ratio were compared among all 3 filling cystometries.
The median age was 4.3 years (IQR 5.8). Of the patients 39 (48.75%) were girls and 41 (51.25%) were boys. Primary pathological finding was myelomeningocele in 69 patients (86.3%). Maximum cystometric capacity, compliance, residual urine and maximum cystometric capacity/estimated bladder capacity for age were found comparable in 3 repeat cystometries. However, maximum detrusor pressure at first filling was higher compared to others (second, p=0.015, and third, p=0.002). Detrusor leak point pressure at the first filling was also higher compared to the third (p <0.001). Detrusor overactivity was persistent in all 3 fillings in 85% of patients (68 of 80). Of the patients 68 (85%) remained in the same risk group according to detrusor leak point pressure (cutoff 40 cmHO).
Maximum cystometric capacity and detrusor overactivity are comparable in 3 repeat cystometries but detrusor pressures significantly decrease in the repeat fillings. In our practice we plan our management according to the most worrisome urodynamics parameters for a safer proactive approach.
国际儿童尿控协会建议至少重复两次尿动力学检查以获得最佳结果。我们旨在研究对于脊髓发育不全导致的神经源性下尿路功能障碍患儿，同一次检查中重复 3 次充盈性尿动力学检查是否会改变尿动力学参数。
我们回顾性分析了 2017 年 6 月至 2018 年 12 月期间 80 例连续接受 3 次同次充盈性膀胱测压检查的脊髓发育不全导致的神经源性下尿路功能障碍患儿的尿动力学报告和图表。比较了 3 次充盈性膀胱测压检查的最大逼尿肌压力、最大膀胱容量、逼尿肌漏点压力、顺应性、残余尿量和最大膀胱容量/年龄预计膀胱容量比值。
患儿的中位年龄为 4.3 岁（IQR 5.8）。其中 39 例（48.75%）为女孩，41 例（51.25%）为男孩。69 例（86.3%）患儿的原发病因为脊髓脊膜膨出。3 次重复充盈性膀胱测压检查的最大膀胱容量、顺应性、残余尿量和最大膀胱容量/年龄预计膀胱容量比值无显著差异。然而，首次充盈时的最大逼尿肌压力高于其他两次（第二次，p=0.015；第三次，p=0.002）。首次充盈时的逼尿肌漏点压力也高于第三次（p<0.001）。85%（80 例中的 68 例）患儿的所有 3 次充盈性膀胱测压检查均存在逼尿肌过度活动。根据逼尿肌漏点压力（截点 40cmH2O），68 例（85%）患儿仍处于同一危险组。
3 次重复充盈性膀胱测压检查的最大膀胱容量和逼尿肌过度活动无显著差异，但重复充盈时逼尿肌压力显著下降。在我们的实践中，我们根据最令人担忧的尿动力学参数制定管理计划，以便采取更安全的主动方法。
