Mundy A R, Shah P J, Borzyskowski M, Saxton H M
Br J Urol. 1985 Dec;57(6):647-51. doi: 10.1111/j.1464-410x.1985.tb07024.x.
Four hundred and two videourodynamic studies were performed on 207 children with neuropathic vesicourethral dysfunction due to myelomeningocele. The children were divided into three groups (contractile, intermediate and acontractile) according to the urodynamic behaviour of their bladders, and the behaviour of the bladder neck and distal sphincter mechanism was assessed in each group. The bladder neck may be competent or incompetent in children with contractile bladders but is never obstructive, and is always incompetent in children with either intermediate or acontractile bladders at their usual bladder volumes. The distal sphincter mechanism is nearly always dynamically obstructive (detrusor-sphincter dyssynergia) in children with contractile bladders but is rarely if ever incompetent, whereas in children with intermediate or acontractile bladders, both (static) distal sphincter obstruction and sphincter weakness incontinence exist to some degree, although the predominance of one of these may mask the existence of the other unless it is specifically looked for or some therapeutic manoeuvre unmasks it. The main conclusion from this study is that, with the possible exception of those few children with more minor partial cord lesions, dysfunction of one or both sphincter mechanisms is the rule in congenital cord lesions.
对207例因脊髓脊膜膨出导致神经源性膀胱尿道功能障碍的患儿进行了402次视频尿动力学检查。根据膀胱的尿动力学表现，将患儿分为三组（收缩性、中间型和无收缩性），并对每组膀胱颈和远端括约肌机制的表现进行评估。收缩性膀胱患儿的膀胱颈可能功能正常或功能不全，但从不梗阻，而中间型或无收缩性膀胱患儿在其通常膀胱容量时膀胱颈总是功能不全。收缩性膀胱患儿的远端括约肌机制几乎总是动态梗阻（逼尿肌-括约肌协同失调），但很少功能不全，而在中间型或无收缩性膀胱患儿中，（静态）远端括约肌梗阻和括约肌无力性尿失禁在某种程度上均存在，尽管其中一种情况占主导可能掩盖另一种情况的存在，除非专门寻找或通过某些治疗手段揭示它。这项研究的主要结论是，除了少数脊髓病变较轻的患儿外，先天性脊髓病变的规律是一种或两种括约肌机制功能障碍。
