Sillén U, Hansson E, Hermansson G, Hjälmås K, Jacobsson B, Jodal U
Department of Pediatric Surgery, Children's Hospital, Göteborg University, Sweden.
Br J Urol. 1996 Oct;78(4):596-601. doi: 10.1046/j.1464-410x.1996.14417.x.
To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract.
methods Thirty-four infants with MMC were investigated using cystometry, micturating cystourethrography and urography at 1, 4 and 10 months of age.
Detrusor contractility was characterized by an increase in activity, with hyper-reflexia in 45% initially, increasing to 65% at the 4-month investigation. During the same period, the number of infants with areflexia decreased from 25% to 12%. Between 4 and 10 months, there were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the first and fourth month. The number of patients with elevated outlet resistance increased only slightly during the first year, from 32% of all infants at the initial investigation to 40% at the 10-month follow-up. Vesico-ureteric reflux was detected in 12 of the patients during the year, with five already diagnosed at the first investigation. Almost all refluxes were cured with clean intermittent catheterization, with additional pharmacological therapy in two patients; one patient required a vesicostomy.
This study indicates that detrusor activity, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in activity and occurred mostly between the first and fourth months of age. There was a strong correlation between the occurrence of reflux and poor compliance, hypercontractility and outlet obstruction.
研究脊髓脊膜膨出（MMC）患儿出生后第一年尿动力学模式的变化，并将这些变化与对上尿路的有害影响相关联。
方法 对34例MMC患儿在1、4和10月龄时进行膀胱测压、排尿性膀胱尿道造影和尿路造影检查。
逼尿肌收缩性的特点是活动增加，最初45%的患儿存在反射亢进，在4月龄检查时增至65%。同一时期，无反射患儿的比例从25%降至12%。在4至10月龄之间，逼尿肌收缩性仅有轻微变化。膀胱顺应性差的患儿数量在第一个月至第四个月之间也有所增加。出口阻力升高的患儿数量在第一年仅有轻微增加，从初始检查时所有患儿的32%增至10月龄随访时的40%。在这一年中，12例患者检测到膀胱输尿管反流，其中5例在首次检查时已被诊断出。几乎所有反流通过清洁间歇性导尿治愈，2例患者还需药物治疗；1例患者需要行膀胱造瘘术。
本研究表明，MMC患儿在出生后第一年逼尿肌活动以及在一定程度上出口阻力会发生变化。这些变化主要是活动增加，且大多发生在1至4月龄之间。反流的发生与顺应性差、收缩亢进和出口梗阻之间存在密切关联。
