Kurzrock E A, Polse S
Childrens Hospital Los Angeles, Department of Urology, University of Southern California, USA.
J Urol. 1998 May;159(5):1657-61. doi: 10.1097/00005392-199805000-00084.
We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value.
We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes.
Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss.
With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.
我们确定了哪些因素预示着骨髓发育不良儿童肾功能恶化的风险更高，并评估了其敏感性和预测价值。
我们回顾性分析了90例脊柱裂儿童的病史、影像学检查和尿动力学资料。初次评估时患者的中位年龄为3个月，平均随访时间为2至25年（平均11年）。我们评估了尿动力学参数和性别与上尿路变化及其变化消退之间的关系。
在漏点压力、顺应性和逼尿肌-括约肌协同失调等尿动力学参数与肾功能恶化之间发现了具有统计学意义的关系，但与恶化的消退无关。男孩和女孩在尿动力学参数方面没有显著差异。女性患者反流和实质损害的发生率较高。
了解尿动力学参数固有的敏感性、特异性和预测价值后，选择性使用尿动力学将有助于识别有肾功能恶化风险的患者。有反流的女性患者实质损害的风险最大。我们主张对通过尿动力学确定为恶化高危的患者尽早实施间歇性导尿。
