De Gennaro M, Capitanucci M L, Capozza N, Caione P, Mosiello G, Silveri M
Pediatric Surgery Department, Bambino Gesu Children's Hospital, Palidoro, Rome, Italy.
Br J Urol. 1998 May;81 Suppl 3:81-5. doi: 10.1046/j.1464-410x.1998.00014.x.
To assess prepubertal boys with posterior urethral valves (PUV) using an analysis of pressure-flow studies to evaluate the voiding phase and thus determine if myogenic failure (hypocontractility) arises before puberty and if it can be detected early.
Eleven boys (8-13 years old) with PUV underwent urodynamics and the results were analysed using pressure-flow mathematical analysis (PFA) of the following variables of detrusor activity: contraction velocity (Vdet), detrusor contractile power expressed as power factor (WF) and Schafer's diagram, which differentiates a 'strong', 'normal' and 'weak' detrusor. Vdet and WF were compared with normal values previously determined in boys of similar age and considered 'low' if more than 2 SDs below the mean. The results of PFA were compared with standard pressure-flow studies and the three classical urodynamic patterns in boys with PUV, as determined by voiding symptoms. The subsequent PFA of seven of the 11 boys were also assessed as they had undergone previous urodynamics when < 8 years old.
As assessed by the three patterns of dysfunction, two boys had bladder instability, two had low compliance and three had hypocontractility, with four boys being normal. From the PFA, the Vdet and WF were lower than normal, respectively, in seven and nine of the 11 boys; Schafer's nomogram showed a 'weak' detrusor in seven boys. The PFA suggested a pathology in four of five boys with symptoms and in three of six with no symptoms (two of the six showing a 'low' WF). Moreover, in older (11-13 years) boys, all five had a 'weak' detrusor, a 'low' WF and four a 'low' Vdet. Of the seven patients who underwent repeat PFA, three had a stable WF 3 years later, one (normal) worsened slightly and two were clearly worse, while one, who underwent late (at 3 years old) valve ablation, had an increased WF.
The PFA showed hypocontractility in two-thirds of prepubertal boys with PUV, including asymptomatic patients. These findings confirm the hypothesis that bladder dysfunction in boys with PUV eventually causes detrusor myogenic failure and finally a postpubertal overdistended bladder.
通过对压力-流率研究进行分析来评估青春期前患有后尿道瓣膜（PUV）的男孩，以评估排尿期，从而确定肌源性衰竭（收缩力减弱）是否在青春期前出现以及能否早期检测到。
11名患有PUV的男孩（8 - 13岁）接受了尿动力学检查，并使用压力-流率数学分析（PFA）对逼尿肌活动的以下变量进行分析：收缩速度（Vdet）、以功率因子（WF）表示的逼尿肌收缩力以及用于区分“强”“正常”和“弱”逼尿肌的 Schafer 图。将Vdet和WF与先前在年龄相似的男孩中确定的正常值进行比较，如果低于平均值超过2个标准差则视为“低”。将PFA的结果与标准压力-流率研究以及根据排尿症状确定的PUV男孩的三种经典尿动力学模式进行比较。11名男孩中的7名随后也接受了PFA评估，因为他们在8岁之前曾接受过尿动力学检查。
根据三种功能障碍模式评估，两名男孩存在膀胱不稳定，两名顺应性低，三名收缩力减弱，四名男孩正常。通过PFA，11名男孩中有7名和9名的Vdet和WF分别低于正常水平；Schafer列线图显示7名男孩的逼尿肌“弱”。PFA表明，有症状的五名男孩中有四名以及无症状的六名男孩中有三名存在病变（六名中有两名WF“低”）。此外，年龄较大（11 - 13岁）的男孩中，所有五名逼尿肌“弱”、WF“低”，四名Vdet“低”。在接受重复PFA的7名患者中，三名3年后WF稳定，一名（正常）略有恶化，两名明显恶化，而一名在3岁时接受晚期瓣膜消融的患者WF增加。
PFA显示三分之二的青春期前患有PUV的男孩存在收缩力减弱，包括无症状患者。这些发现证实了以下假设，即患有PUV的男孩的膀胱功能障碍最终会导致逼尿肌肌源性衰竭，最终导致青春期后膀胱过度扩张。
