Lower urinary tract function in childhood; normal development and common functional disturbances

This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4–6 and the detrusor muscle is formed during weeks 9–12 of gestation. Higher CNS centres are involved in micturition at birth, and the infant usually wakes up, at least briefly, to void. Voiding during the first years of life is often incomplete, owing to detrusor‐sphincter dyscoordination, but this disappears when bladder control is attained. Approximately 5–10% of 7‐year‐old children suffer from daytime incontinence and/or nocturnal enuresis, and a few per cent of them will not outgrow it. Daytime incontinence in childhood is usually attributable to detrusor overactivity, although it is unclear to what extent it is the detrusor or the micturition reflex per se that is overactive. Enuresis – nocturnal incontinence – is caused by either nocturnal polyuria and/or nocturnal detrusor overactivity, in both cases combined with high arousal thresholds. Bladder problems in childhood constitute a risk factor for the development or persistence of bladder problems in adulthood.     

前列腺增生致膀胱出口梗阻后逼尿肌功能改变对尿动力学参数的影响

目的探讨良性前列腺增生症（BPH）致膀胱出口梗阻（BOO）后逼尿肌功能改变对尿动力学参数的影响。方法109例具有完整尿动力学结果的BPH患者根据有无B00分为梗阻组和非梗阻组;梗阻组根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级4组;逼尿肌收缩力分为逼尿肌收缩力减弱（DCA）与收缩力正常组;逼尿肌不稳定（DI）分DI与非DI;膀胱顺应性（BC）分高、正常、低顺应性三组;28例患者行经尿道前列腺切除术（TURP）术前及术后尿动力参数对比。结果BOO组的前列腺体积（PV）、国际前列腺症状评分（IPSS）、DI、急性尿潴留（AUR）发生率明显高于非BOO组（P〈O．05）;BOO组的最大尿流率（Qmax）、BC值、DCA发生率明显低于非BOO组（P〈0．05）;逼尿肌收缩力正常组的残余尿（RV）与BC值明显低于减弱组（P〈0．05）,而BOO和DI的发生率明显高于减弱组（P〈0．01）;DI组的年龄、BC值及DCA的发生率明显低于非DI组（P〈0．05）,而B00级别和AUR的发生率明显高于非DI组（P〈0．01）;低BC组IPSS、BOO级别、AUR发生率明显高于正常及高BC组（P〈0．05）,而DCA发生率明显低于正常及高BC组（P〈0．01）;术后Qmax、BC值较术前明显升高（P〈0．05）,RV、IPSS、DI发生率较术前明显减小（P〈0．01）。结论①BOO常与低顺应性膀胱、DI、AUR合并存在;②IPSS评分不能提示是否存在DI,DI的存在不影响IPSS评分;③TURP是治疗前列腺增生的金标准;④尿动力检查能全面了解有无BOO及BOO所致逼尿肌功能改变情况,对BPH的临床鉴别诊断、预后估计及选择恰当治疗方案都具有重要意义。     

Management of Sphincter Dyssynergia Using the Sphincter Stent Prosthesis in Chronically Catheterized SCI Men

Abstract

This effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6±3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement.

Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77±23 cmH20 preoperatively to 35±18 cmH20 at 12 months (n=34) and 33±20 cmH2Û at 24 months (n=22) after stent insertion (p=0.001). Post-void residual urinary volume decreased from 202±187 ml preinsertion to 64±69 ml at 24 months (p=0.001) postinsertion. Maximum cystometric capacity remained constant at 201 ±144 ml preinsertion to 203±79 ml at 24 months (p=0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n=10) and without (n=31) previous external sphincterotomy.

Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient. No deleterious effects were observed on erectile function. Hydronephrosis resolved in four, and improved in three, of seven patients with hydronephrosis preoperatively. Eighty-two percent of the patients demonstrated complete stent epithelialization after six months, while 96 percent were epithelialized two years after stent insertion. In three patients, stent migration required repositioning or removal within the first month. In another two patients, the stent prostheses were removed one year postinsertion because of problems with condom catheter drainage.

The sphincter stent prosthesis is an attractive, potentially reversible treatment option for DESD in men managed with an indwelling catheter, even if external sphincterotomy has been performed previously. (J Spinal Cord Med;] 8:88–94)