Jia Z M, Wen J G, Zhu W, Zhang R L, Wang Y, Zhang C Y, Wang C Y, Ye Z, Ren C C, Wang Q W
Department of Urology and Urodynamic Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2021 Jan 12;101(2):142-146. doi: 10.3760/cma.j.cn112137-20200519-01591.
To explore the clinical value of ambulatory urodynamics monitoring (AUM) in the diagnosis and treatment of children with refractory monosymptomatic nocturnal enuresis (RMNE) by comparing the urodynamic parameters of AUM with those of conventional urodynamics (CUD). A total of 40 children (22 males and 18 females) diagnosed with RMNE in the First Affiliated Hospital of Zhengzhou University from May 2017 to September 2019 were collected. They were aged 9-16 years, and their frequency of nocturnal bed-wetting was≥2 times per week. CUD and one sleep cycle AUM were performed, respectively. Then, the urodynamic parameters were recorded and analyzed. Five of the 40 children dropped out of the study because of the poor compliance. The age of children with RMNE was(12.6±2.1)years old, the ratio of male to female was 19∶16, and the severity of enuresis (enuresis frequency) was(4.2±1.7) times per week. Compared to the CUD group, the bladder compliance (BC) [(28.4±7.7) ml/cmHO vs (23.6±6.1) ml/cmHO(1 cmHO=0.098 kPa)] and maximum detrusor pressure (Pmax.det) [(44.6±9.1) cmHO vs (36.8±8.3) cmHO] in the AUM group were significantly higher (<0.05). The maximum flow rate (Qmax) [(19.6±7.2) ml/s vs (20.9±5.4) ml/s] and post void residual (PVR) [(9.5±5.7) ml vs (10.9±5.3) ml] between the two groups showed no statistically significant differences (>0.05). Detrusor overactivity (DO) was detected in 27 cases (77.1%) during AUM and in 16 cases (45.7%) during CUD; the difference was statistically significant (<0.05). Among them, 15 cases (42.9%) with DO were detected both in CUD and AUM, while 12 (34.3%) with DO were not detected in CUD. For the 15 cases with DO detected by both CUD and AUM, the frequency [(3.1±1.0) times/h vs (2.4±0.8) times/h] and maximum value of DO [(22.9±4.5) cmHO vs (19.2±4.0) cmHO] in the AUM group were both higher than those in the CUD group (<0.05). Bladder dysfunction can be diagnosed in children with RMNE using AUM. Furthermore, AUM is more accurate than CUD in evaluating BC, Pmax.det, DO, and other parameters. For children with RMNE and with unsatisfactory CUD results, further AUM examination is recommended to clarify the etiology.
通过比较动态尿动力学监测（AUM）与传统尿动力学（CUD）的尿动力学参数，探讨动态尿动力学监测在难治性单症状性夜间遗尿症（RMNE）患儿诊断和治疗中的临床价值。收集了2017年5月至2019年9月在郑州大学第一附属医院诊断为RMNE的40例患儿（男22例，女18例）。他们年龄在9 - 16岁，夜间尿床频率≥每周2次。分别进行CUD和一个睡眠周期的AUM。然后，记录并分析尿动力学参数。40例患儿中有5例因依从性差退出研究。RMNE患儿年龄为（12.6±2.1）岁，男女比例为19∶16，遗尿严重程度（遗尿频率）为每周（4.2±1.7）次。与CUD组相比，AUM组的膀胱顺应性（BC）[（28.4±7.7）ml/cmH₂O 对（23.6±6.1）ml/cmH₂O（1 cmH₂O = 0.098 kPa）]和最大逼尿肌压力（Pmax.det）[（44.6±9.1）cmH₂O 对（36.8±8.3）cmH₂O]显著更高（P < 0.05）。两组间的最大尿流率（Qmax）[（19.6±7.2）ml/s 对（20.9±5.4）ml/s]和排尿后残余尿量（PVR）[（9.5±5.7）ml 对（（10.9±5.3）ml]差异无统计学意义（P > 0.05）。AUM期间检测到27例（77.1%）逼尿肌过度活动（DO），CUD期间检测到16例（45.7%）；差异有统计学意义（P < 0.05）。其中，CUD和AUM均检测到DO的有15例（42.9%），CUD未检测到而AUM检测到DO的有12例（34.3%）。对于CUD和AUM均检测到DO的15例患儿，AUM组DO的频率[（3.1±1.0）次/小时 对（2.4±0.8）次/小时]和最大值[（22.9±4.5）cmH₂O 对（19.2±4.0）cmH₂O]均高于CUD组（P < 0.05）。使用AUM可诊断RMNE患儿的膀胱功能障碍。此外，AUM在评估BC、Pmax.det、DO等参数方面比CUD更准确。对于RMNE且CUD结果不理想的患儿，建议进一步进行AUM检查以明确病因。
