小儿遗尿与膀胱输尿管反流的相关性研究

目的 探讨小儿遗尿与膀胱输尿管反流(vesicoureteral reflux,VUR)的关系,筛选小儿VUR的高危因素为临床诊治提供依据.方法 选取郑州大学第一附属医院小儿尿动力学中心以遗尿为主诉就诊并且神经功能正常的儿童和青少年83例(男36例,女47例),年龄5～16岁,平均(9.42±3.21)岁.所有患儿进行排尿性膀胱尿道造影(VCUG)检查以评估VUR情况,并进行尿常规、尿培养、肾脏和膀胱超声检查.尿动力学检查包括尿流率、盆地肌电图和膀胱压力容积测定.泌尿系检查的准入标准包括泌尿系超声异常、白天尿失禁、尿动力学检查异常、尿路感染或者同胞兄妹中有VUR病史等.结果 48例(57.8％)出现单症状性夜遗尿(MNE),35例(42.2％)非单症状性夜遗尿(NMNE).13例(15.7％)出现VUR.t检验结果显示,白天尿失禁患儿、女性患儿和当前伴有尿路感染的患儿VUR发病率明显升高(P＜0.05);多自变量logistic回归分析结果显示,只有性别、白天尿失禁和当前尿尿路感染的回归系数检验有统计学意义(P＜0.05),VUR与患儿年龄、遗尿类型(原发性、继发性)、遗尿频率、有无遗尿家族史、尿路感染病史、有无排便异常和除白天尿失禁外的白天尿路症状无统计学意义(P＞0.05).结论 VUR明显常见于白天尿失禁的遗尿患儿,建议存在白天尿失禁的遗尿患儿进一步进行相关检查.当前尿路感染是遗尿患儿发生VUR的高危因素.

Correlation of nocturnal enuresis with vesicoureteral reflux: a report of 83 cases

Objective To explore the relationship between vesicoureteral reflux (VUR) and nocturnal enuresis in children,screen for the risk factors of pediatric VUR and provide rationales for clinical management.Methods This study recruited 83 neurologically normal children and adolescents with a chief complaint of nocturnal enuresis with ultrasonic renal abnormalities,daytime incontinence,urodynamic abnormalities or siblings with a history of VUR.There were 36 boys and 47 girls with an average age of 9.42 ± 3.21 (5-16) years.Voiding cystourethrography (VCUG) was performed for assessing the status of VUR.Also urine routine,urine culture and urological ultrasound scan were performed.Measurement of urinary dynamics,including urinary flow rate,basin electromyography (EMG) and bladder pressure volume,were recorded.Results There were monosymptomatic nocturnal enuresis (MNE) (n=48,57.8％) and non-monosymptomatic nocturnal enuresis (NMNE) (n =35,42.2％).And 13 cases (15.7％) had VUR.The incidence was significantly higher for daytime urinary incontinence,girls with VUR and current urinary tract infections (UTI) (P =0.019,0.006 & 0.017 respectively).Logistic multifactor regression analysis showed that only gender,daytime incontinence and current UTI were statistically significant (P＜0.05).The types of primary or secondary enuresis,enuresis frequency,a history of UTI and urinary tract daytime symptoms except for daytime incontinence had no significant statistical difference (P＞0.05).Condnsions VUR is common in children with enuresis and daytime incontinence.The relevant examinations are recommended.And UTI is a risk factor for its occurrence.