Department of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, Beijing, China.
University of Health and Rehabilitation Sciences, Qingdao, China.
Front Endocrinol (Lausanne). 2022 Jul 22;13:941453. doi: 10.3389/fendo.2022.941453. eCollection 2022.
To describe the urinary tract characteristics of diabetes insipidus (DI) patients with upper urinary tract dilatation (UUTD) using the video-urodynamic recordings (VUDS), UUTD and all urinary tract dysfunction (AUTD) systems, and to summarize the experience in the treatment of DI with UUTD.
This retrospective study analyzed clinical data from 26 patients with DI, including micturition diary, water deprivation tests, imaging data and management. The UUTD and AUTD systems were used to evaluate the urinary tract characteristics. All patients were required to undergo VUDS, neurophysiologic tests to confirm the presence of neurogenic bladder (NB).
VUDS showed that the mean values for bladder capacity and bladder compliance were 575.0 ± 135.1 ml and 51.5 ± 33.6 cmHO in DI patients, and 42.3% (11/26) had a post-void residual >100 ml. NB was present in 6 (23.1%) of 26 DI patients with UUTD, and enterocystoplasty was recommended for two patients with poor bladder capacity, compliance and renal impairment. For the 24 remaining patients, medication combined with individualized and appropriate bladder management, including intermittent catheterization, indwelling catheter and regular voiding, achieved satisfactory results. High serum creatinine decreased from 248.0 ± 115.8 μmoI/L to 177.4 ± 92.8 μmoI/L in 12 patients from a population with a median of 108.1 μmoI/L (IQR: 79.9-206.5 μmoI/L). Forty-four dilated ureters showed significant improvement in the UUTD grade, and the median grade of 52 UUTD ureters decreased from 3 to 2.
Bladder distension, trabeculation and decreased or absent sensations were common features for DI patients with UUTD. Individualized therapy by medication combined with appropriate bladder management can improve UUTD and renal function in DI patients.
使用视频尿动力学记录（VUDS）、上尿路扩张（UUTD）和所有尿路功能障碍（AUTD）系统描述伴有上尿路扩张（UUTD）的尿崩症（DI）患者的尿路特征，并总结治疗伴有 UUTD 的 DI 的经验。
本回顾性研究分析了 26 例 DI 患者的临床资料，包括排尿日记、禁水试验、影像学资料和处理措施。使用 UUTD 和 AUTD 系统评估尿路特征。所有患者均需进行 VUDS、神经生理测试以确认是否存在神经性膀胱（NB）。
VUDS 显示，DI 患者的膀胱容量和顺应性平均值分别为 575.0±135.1ml 和 51.5±33.6cmHO，其中 42.3%（11/26）的患者残余尿量>100ml。26 例伴有 UUTD 的 DI 患者中，有 6 例（23.1%）存在 NB，对于 2 例膀胱容量、顺应性和肾功能较差的患者，建议行肠膀胱扩大术。对于其余 24 例患者，药物联合个体化、适当的膀胱管理（包括间歇性导尿、留置导尿和定期排尿）取得了满意的效果。12 例患者的血清肌酐从 248.0±115.8μmoI/L 降至 177.4±92.8μmoI/L，中位数为 108.1μmoI/L（IQR：79.9-206.5μmoI/L）。44 根扩张的输尿管 UUTD 分级明显改善，52 根输尿管 UUTD 的中位数从 3 级降至 2 级。
DI 患者伴有 UUTD 时，膀胱扩张、小梁化和感觉减退或缺失较为常见。药物联合适当的膀胱管理的个体化治疗可以改善 DI 患者的 UUTD 和肾功能。
