Flood H D, Ritchey M L, Bloom D A, Huang C, McGuire E J
Department of Surgery, University of Michigan Hospitals, Ann Arbor.
J Urol. 1994 Nov;152(5 Pt 1):1574-7. doi: 10.1016/s0022-5347(17)32478-3.
From June 1984 to December 1992 voiding cystourethrography performed on 209 patients with myelodysplasia revealed vesicoureteral reflux in 57 (27%). High grade reflux (3 to 5/5) occurred in 33 patients (58%). Bladder pressure at typical capacity, defined as the pressure at average catheterization volume or bladder leak point pressure, was determined urodynamically. After a mean of 56 months vesicoureteral reflux resolved or improved in 55% of patients and remained unchanged in 28%. There was no correlation between the grade of reflux and the rate of spontaneous resolution. Pressure at typical capacity of 40 cm. water or more was significantly more common in patients with reflux (44%) than in those with no reflux (20%) (p < 0.001). There was a strong association between pressure at typical capacity of 40 cm. water or more and upper tract deterioration (p < 0.0001). However, there was no correlation between pressure at typical capacity and grade of reflux (p = 0.18). Treatment of pressure at typical capacity of 40 cm. water or more led to resolution or improvement of vesicoureteral reflux in 8 of 10 reevaluated patients. Hydronephrosis resolved (7) or improved (1) in 8 of 9 cases. Measurement of intravesical pressure is of paramount importance in the management of spina bifida patients with vesicoureteral reflux. Maintaining the pressure at typical capacity at less than 40 cm. water is associated with increased spontaneous resolution of vesicoureteral reflux and a lower incidence of upper tract deterioration.
1984年6月至1992年12月，对209例脊髓发育不良患者进行了排尿性膀胱尿道造影，结果显示57例（27%）存在膀胱输尿管反流。33例患者（58%）出现重度反流（3至5/5级）。通过尿动力学测定典型容量时的膀胱压力，典型容量定义为平均导尿体积时的压力或膀胱漏点压力。平均56个月后，55%的患者膀胱输尿管反流缓解或改善，28%的患者反流情况保持不变。反流程度与自发缓解率之间无相关性。反流患者中典型容量压力达到或超过40 cm水柱的情况（44%）显著多于无反流患者（20%）（p<0.001）。典型容量压力达到或超过40 cm水柱与上尿路恶化之间存在密切关联（p<0.0001）。然而，典型容量压力与反流程度之间无相关性（p = 0.18）。对10例重新评估的典型容量压力达到或超过40 cm水柱的患者进行治疗，其中8例患者的膀胱输尿管反流得到缓解或改善。9例肾积水患者中有8例（7例缓解，1例改善）。对于患有膀胱输尿管反流的脊柱裂患者，测量膀胱内压力在治疗中至关重要。将典型容量时的压力维持在40 cm水柱以下，可使膀胱输尿管反流的自发缓解率增加，上尿路恶化的发生率降低。
