Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Diagnostic Imaging, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Scand J Urol. 2021 Jun;55(3):249-256. doi: 10.1080/21681805.2020.1866067. Epub 2020 Dec 30.
Approximately, 1% of school children have daytime urinary incontinence. The symptoms may be caused by an overactive bladder (OAB). In the evaluation of boys with OAB complaints, one should consider a possible urethral cause. The aim of the study was to evaluate the value of a diagnostic regime with cystourethroscopy, voiding cystourethrography (VCUG) and urodynamic pressure-flow studies in boys with OAB complaints after unsuccessful urotherapy and pharmacological therapy. Seventy-five boys (5-14 years old) were investigated with cystourethroscopy and within 24 h thereafter VCUG followed by urodynamic combined cystometry and pressure-flow study. All boys had daytime incontinence and urgency. Sixty-one boys had no suspected urethral valves at cystoscopy or VCUG, and urodynamics showed no obstructed Pdet-Qmax. All 61 boys had detrusor overactivity. Two boys had late diagnosed urethral valves. In four boys, the initial cystourethroscopy was described as normal. The VCUG indicated presence of posterior urethral valves, but urodynamics showed no obstructed Pdet-Qmax. In eight boys, the initial cystourethroscopy was described as normal whereas urodynamics showed obstructed Pdet-Qmax. In four of these boys, VCUG showed abnormalities in the sphincter area but they were not described as suspected urethral valves. At repeat cystourethroscopy, urethral valves could still not be identified. Patient follow-up regarding achievement of continence after investigation guided treatment was in accordance with the literature. Boys can be safely evaluated by cystourethroscopy followed by urodynamics in search for a possible urethral problem. It is our suggestion, that VCUG can be restricted to those boys where urodynamics indicates obstruction or the findings by cystourethroscopy are uncertain.
大约有 1%的学童患有日间尿失禁。这些症状可能是由膀胱过度活动症（OAB）引起的。在评估有 OAB 症状的男孩时，应考虑到可能存在尿道问题。本研究旨在评估在经过不成功的尿路治疗和药物治疗后，对有 OAB 症状的男孩进行膀胱尿道镜检查、排尿性膀胱尿道造影（VCUG）和尿动力学压力-流研究的诊断方案的价值。75 名男孩（5-14 岁）接受了膀胱尿道镜检查，随后在 24 小时内进行了 VCUG，然后进行了尿动力学联合膀胱测压和压力-流研究。所有男孩均有日间尿失禁和尿急。61 名男孩在膀胱尿道镜检查或 VCUG 时均未发现疑似尿道瓣膜，尿动力学检查显示 Pdet-Qmax 无梗阻。所有 61 名男孩均存在逼尿肌过度活动。2 名男孩被迟发性诊断为尿道瓣膜。4 名男孩的初始膀胱尿道镜检查结果正常。VCUG 显示存在后尿道瓣膜，但尿动力学检查显示 Pdet-Qmax 无梗阻。8 名男孩的初始膀胱尿道镜检查结果正常，但尿动力学检查显示 Pdet-Qmax 梗阻。在这 8 名男孩中，4 名的尿动力学检查显示存在梗阻，但 VCUG 检查并未显示出存在疑似尿道瓣膜的异常。在重复膀胱尿道镜检查时，仍然无法识别出尿道瓣膜。根据文献，对这些男孩进行调查后的治疗是根据患者是否达到了持续尿控的目标来进行的。男孩可以通过膀胱尿道镜检查安全地进行评估，然后进行尿动力学检查以寻找可能的尿道问题。我们的建议是，VCUG 可以限制在那些尿动力学检查显示梗阻或膀胱尿道镜检查结果不确定的男孩中进行。
