脊髓拴系综合征患者的尿流动力学特征及其临床意义

目的　探讨脊髓拴系综合征患者（TCS）尿流动力学特征及其临床意义。方法　对94例患者采用显微松解术于术前1周及术后3～6个月内行尿流动力学检查。结果　80例（85.1%）TCS患者存在下尿路症状，尿流动力学检查A组（有下尿道症状组）均存在神经源性损害；B组（无下尿道症状组）14例中11例存在神经源性损害。A组和B组膀胱输尿管返流率分别为43.8%和14.3%。α组（无上尿道损害组）最大尿道闭合压（MUCP）为45cmH

Urodynamic characteristics of patients with tethered cord syndrome and its clinical significance

OBJECTIVE: To evaluate the urodynamic characteristics of children with tethered cord syndrome (TCS) and its clinical significance. METHODS: We conducted urodynamic studies in 94 cases of TCS who underwent microsurgical release within one week preoperatively and 3 to 6 months postoperatively. RESULTS: 80 out of 94 (85.1%) children with TCS presented with lower urinary tract symptoms. Neuropathic injuries were found both in patients in group A (with lower urinary tract symptoms) and in 11 out of 14 patient in group B (without lower urinary tract symptoms). The maximum urethral closing pressure (MUCP) and maximum detrusor pressure (MDP) were significantly lower in group alpha (without upper urinary tract injury), which were 45 cm H(2)O +/- 18 cm H(2)O and 27 cm H(2)O +/- 15 cm H(2)O respectively, than in group beta (with upper urinary tract injury), which were 69 cm H(2)O +/- 24 cm H(2)O and 44 cm H(2)O +/- 17 cm H(2)O respectively, while bladder compliance (BC) in group alpha (5.6 cm H(2)O +/- 0.9 ml/cm H(2)O) was significantly higher than in group beta (2.5 ml/cm H(2)O +/- 1.2 ml/cm H(2)O). MUCP, MDP and BC were improved in group I (primary TCS) after cord untethering, 32 cm H(2)O +/- 14 cm H(2)O, 21 cm H(2)O +/- 12 cm H(2)O, 9.5 ml/cm H(2)O +/- 1.3 ml/cm H(2)O postoperatively and 63 cm H(2)O +/- 245 cm H(2)O, 37 cm H(2)O +/- 156 cm H(2)O, 5.1 ml/cm H(2)O +/- 0.8 ml/cm H(2)O preoperatively respectively, while in group II remained unchangeable. CONCLUSION: Urodynamic studies are effective methods to identify neuropathic characteristics of lower urinary tract symptom in children with TCS and to find neuropathic injury during subclinical period. According to urodynamic studies, increase of MUCP and DP and decrease of BC are high risk factors of vesicoureteral reflux and upper urinary tract injury. Microsurgical release can improve bladder function in primary TCS, while do no good to bladder function in secondary TCS.