Holmdahl G
Department of Pediatrics (Pediatric Surgery) Sahlgrenska University Hospital/Ostra Göteborg University.
Scand J Urol Nephrol Suppl. 1997;188:1-36.
Posterior urethral valve (PUV) is a congenital urethral obstruction affecting boys. As a result of the obstruction in fetal life, these boys often have a persisting bladder dysfunction, which is one of the main causes of the late onset renal failure seen in 1/3 of the boys and is also responsible for the delayed achievement of continence. The aim of this study was to characterize the bladder dysfunction from infancy through childhood and adolescence in boys with neonatally diagnosed PUV with the intention of designing a bladder treatment regimen starting in infancy. Paper I: 16 infant boys with PUV were followed with repeated standard cystometries. At presentation the bladders were hypercontractile with low capacity. During the first three years of life the urodynamic pattern changed, with vanishing hypercontractility and increasing bladder capacity, even though the instability remained unchanged. Paper II: 12 boys were followed with standard cystometries between 4 and 12 years of age and compared with a group of 6 postpubertal boys with PUV. The urodynamic pattern continued to change, with decreasing instability and contractility. A major problem was emptying difficulties. Paper III: The voiding pattern during the day versus the night in 10 incontinent and 6 continent boys with PUV was evaluated by long-term natural filling cystometry. The voiding pattern, with small frequent voidings during the day and few or no voidings during the night with high bladder volumes in the morning, could be explained by pronounced instability during the day whereas the bladders were stable during the night. Paper IV: The method of "4 hour voiding observation" was presented as a non-invasive method for basic assessment of bladder function in non-toilet trained children and the voiding pattern in 43 healthy infants was demonstrated. Paper V: The voiding pattern, with special attention to emptying difficulties, in 25 small children with PUV compared to healthy children of corresponding age, was evaluated with the "4 hour voiding observation."
Boys with PUV have a bladder dysfunction with a changing urodynamic pattern over time with decreasing contractility and instability. In small boys the instability was pronounced during daytime while during the night the bladders were mainly stable. Most boys with PUV and bladder dysfunction end up with a deconpensated bladder. A major problem was bladder emptying difficulties. The "4 hour voiding observation" is an excellent non-invasive method of identifying those patients in need of early bladder treatment, i.e. with clean intermittent catheterisation.
后尿道瓣膜（PUV）是一种影响男孩的先天性尿道梗阻。由于胎儿期的梗阻，这些男孩常伴有持续的膀胱功能障碍，这是三分之一男孩出现迟发性肾衰竭的主要原因之一，也是导致控尿延迟的原因。本研究的目的是描述新生儿期诊断为PUV的男孩从婴儿期到儿童期及青春期的膀胱功能障碍特征，以便设计从婴儿期开始的膀胱治疗方案。论文一：对16名患有PUV的男婴进行反复标准膀胱测压随访。初诊时膀胱收缩亢进且容量小。在生命的头三年里，尿动力学模式发生了变化，收缩亢进消失，膀胱容量增加，尽管不稳定性保持不变。论文二：对12名4至12岁的男孩进行标准膀胱测压随访，并与6名青春期后患有PUV的男孩进行比较。尿动力学模式持续变化，不稳定性和收缩性降低。一个主要问题是排空困难。论文三：通过长期自然充盈膀胱测压评估10名失禁和6名控尿的患有PUV的男孩白天与夜间的排尿模式。白天频繁小量排尿、夜间很少或无排尿且早晨膀胱容量高的排尿模式，可以用白天明显的不稳定性来解释，而夜间膀胱是稳定的。论文四：提出了“4小时排尿观察”方法，作为一种对未接受如厕训练儿童膀胱功能进行基本评估的非侵入性方法，并展示了43名健康婴儿的排尿模式。论文五：用“4小时排尿观察”评估25名患有PUV的幼儿与相应年龄健康儿童相比的排尿模式，特别关注排空困难情况。
患有PUV的男孩存在膀胱功能障碍，尿动力学模式随时间变化，收缩性和不稳定性降低。小男孩白天不稳定性明显，而夜间膀胱主要是稳定的。大多数患有PUV和膀胱功能障碍的男孩最终会出现膀胱失代偿。一个主要问题是膀胱排空困难。“4小时排尿观察”是一种极好的非侵入性方法，可用于识别那些需要早期膀胱治疗（即清洁间歇性导尿）的患者。
