1026例男性尿流率调查

目的界定排尿正常男性的各项排尿数据。方法将1026例30岁以上志愿者或无下尿路症状性疾病的就诊者，按年龄分为6组，A组30-岁，238例；B组40-岁，329例；C组50-岁，227例；D组60-岁，93例；E组-70。岁，78例；F组80岁以上，61例。分别作尿流率检测，观察其最大尿流率（Qmax）、平均尿流率（Qave）、排尿量、排尿时间和尿流时间。结果各组排尿量间差别无显著性意义（P〉0．05）；Qmax和Oave随年龄的增大而逐渐下降（P〈0．05）。结论初步显示了各年龄组排尿正常男性的各项排尿数据，可作为评价排尿活动的参数。     

前列腺(厚径)~2/宽径计算值与高最大尿流率关系

本文分析82例男性高最大尿流率与前列腺（厚径）2／宽径计算值、排尿前膀胱容积、残余尿及分布、年龄等相关因素。高最大尿流率与前列腺大小形态有关．与通尿肌增生或膀胱内压升高相关更明显；其残余尿与尿流率大小无关，而残余尿分布与排尿前膀胱容积有关，出现在排尿前膀胱容积大者，年龄相对较小、最大尿流率随年龄增加而降低，但本组中已不再显示年龄均值差异。加之在最大尿流率诺模图标准差区间等综合分析，有助诊断与比较。     

前列腺（厚径）^2／宽径计算值与高最大尿流率关系

本文分析８２例男性高最大尿流率与前列腺（厚径）＾２／宽径计算值、排尿前膀胱容积、残余尿及分布，年龄等相关因素，高最大尿流率与前列腺大小形态有关，与逼尿肌增生或膀胱内压升高相关更明显；其残余尿与尿流率大小无关，而残余尿分布与排尿前膀胱容积有关，出现在排尿前膀胱容积大者，年龄相对较小。最大尿流率随年龄增加而降低，但本组中已不再显示年龄均值差异。加之在最大尿流率诺模图标准差区间等综合分析，有助诊断与比较     

耦合法修复尿道下裂的功能性效果评价

目的 评价口腔黏膜片移植与局部皮瓣耦合组建尿道修复尿道下裂的功能性效果.方法 17例先天性尿道下裂患儿行口腔黏膜片移植与局部皮瓣耦合再造尿道术修复尿道下裂.术前1d和术后1年对患儿进行尿流率测定检查,记录尿流率、尿量、排尿时间等参数,描记尿流曲线.将最大尿流率在Toguri尿流率列线图上进行描点分析.结果 术前17例患儿的最大尿流率为(7.89+2.29) ml/s,其中12例(70.6％)尿流率曲线呈平台形,5例(29.4％)尿流率曲线低平；在Toguri尿流率列线图上描点分析,12例(70.6％)最大尿流率在正常儿童的第5百分位数曲线以下.耦合法再造尿道术后1年随访,17例患儿的最大尿流率为(11.30±3.01) ml/s,其中10例(58.8％)患儿的尿流率曲线接近正常的钟形曲线；7例(41.2％)最大尿流率位于正常儿童的第25百分位数曲线以上,8例(47.1％)位于正常儿童的第25百分位数与第5百分位数曲线之间,2例(11.8％)在第5百分位数曲线以下.结论 耦合法组建尿道修复尿道下裂的功能性效果良好,手术后患者的最大尿流率提高.     

体位对BPH患者尿流率和剩余尿的影响

目的:研究体位对BPH患者尿流率测定和剩余尿的影响。方法:本研究选择45名有症状的BPH患者,分别于站立、坐位和卧位三种体位进行尿流率测定,每次排尿后的剩余尿通过腹部B超获得。比较三种体位最大尿流率(Qmax),平均尿流率(Qave),排尿量(VV)和剩余尿量(PVR)。结果:患者立位、坐位和卧位Qmax为(16.2±0.37)ml/s、(15.4±0.46)ml/s和(9.5±0.55)ml/s,Qave分别为(6.4±0.21)ml/s、(6.0±0.30)ml/s和(4.7±0.31)ml/s,VV分别为(267.6±10.14)ml、(251.3±12.53)ml和(181.1±8.17)ml,PVR为(63.2±12.17)ml、(67.5±10.36)ml和(101.2±16.42)ml。立位、坐位两种体位对最大尿流率、平均尿流率、排尿量和剩余尿均无影响,卧位时尿流率下降,剩余尿增加。结论:立位和坐位不影响BPH患者的尿流率和剩余尿,卧位时尿流率下降,剩余尿增加。     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

多沙唑嗪显著改善膀胱出口梗阻患者的下尿路症状

为评估多沙唑嗪在治疗有下尿路症状（LUTS）的膀胱出口梗阻患者时的尿动力学变化以及其与排尿症状的相关性。Gerber GS等筛选了50位有LUTS的患者，应用多沙唑嗪4mg／d治疗3个月，治疗前后测定IPSS评分、尿流率和综合的尿动力学参数（Urology 47（6）：840—844）。结果，44位患者（88％）完成治疗前后的评估，平均LPSS评分从20．6降为10．5（P〈0．001），平均最大尿流率从11．7mL／s增加到13．2mL／s（P=0．20），最大尿流率时的平均逼尿肌压力从93．6cmH2O降到83．0cmH2O（P=0．15）。平均膀胱顺应容量从266mL增加到304mL（P=0．07）。应用A-G列线图，超过58％的患者在用多沙唑嗪治疗3个月后仍存在梗阻。但是无论有无膀胱出口道梗阻的客观证据，所有的患者最后在排尿症状方面均有相似的改善。大多数患者在完成实验后继续选择多沙唑嗪治疗（41／44，93%）。由此得出结论，     

肠道新膀胱尿动力学检查的临床意义

目的 探讨全膀胱切除肠代膀胱术后患者新膀胱和尿道的尿动力学特点。方法 全膀胱切除回肠原位新膀胱术患者22例，术后6～55个月，平均28个月。尿动力学检查测定尿流率、剩余尿，充盈期、排尿期膀胱测压、直肠测压、括约肌肌电图和尿道压测定。结果 22例患者最大尿流率2．7～22．1ml／s，平均12．9ml／s；排尿时间17～240s，平均66s；剩余尿5～300ml，平均92ml；最大膀胱容量210～650ml，平均426ml；初次尿意膀胱容量137～540ml，平均296ml；急迫尿意膀胱容量200～620ml，平均388ml。充盈末期膀胱内压均〈50cmH2O，顺应性31～35ml／cmH2O，平均33ml／cmH2O。膀胱容量≤50％时充盈期新膀胱不自主收缩平均1．2次，容量〉50％～100％时2．6次。压力流率测定时患者排尿期新膀胱均未见主动收缩，排尿期最大腹压10～105cmH2O，平均64cmH2O。最大尿道闭合压33～114cmH2O，平均69cmH2O。功能性尿道长度17～56mm，平均37mm。结论 回肠新膀胱具有良好的储尿能力，新膀胱排尿主要依靠腹压和尿道的协同作用，保留尿道的控尿能力是保证术后控尿能力的关键。     

压力-流率测定中尿道内置测压导管对尿流率的影响

目的　探讨尿道内置测压管在压力 流率测定中对尿流率的影响。　方法　对 4 4例良性前列腺增生 (BPH)患者进行自由尿流率和压力 流率测定。压力 流率测定中尿道内放置 7F测压导管。统计学分析比较自由尿流率和置管后尿流率的变化。　结果　 4 4例患者自由尿流率和带管尿流率的排尿量分别为 (174 .72± 74 .6 2 )ml和 (186 .4 8± 6 9.71)ml(P >0 .0 5 )。最大自由尿流率(9 .5 5± 4 .10 )ml/s ,最大带管尿流率 (7.32± 3.2 8)ml/s(P =0 .0 0 0 )。最大尿流率下降值为 (2 .2 2± 3.0 7)ml/s。膀胱出口梗阻 (BOO) 0～Ⅰ级、Ⅲ级和Ⅳ级时自由尿流率和带管尿流率两者差异有显著性意义 (P <0 .0 5 ) ,BOOⅡ级、Ⅴ～Ⅵ级时自由尿流率和带管尿流率差异无显著性意义 (P >0 .0 5 )。　结论　尿道内置 7F测压导管可影响最大尿流率测定值。     

Uroflowmetry nomogram in Iranian children aged 7 to 14 years

Background

As the voiding habits of Iranian children differs from other children because of some cultural and religious considerations, we aimed to establish normal reference values of urinary flow rates in Iranian children between 7 to 14 years of age.

Methods

Eight hundred and two uroflowmetry studies were performed on children with no history of a renal, urological, psychological or neurological disorder, between the ages 7 and 14. Five hundred twenty five studies from 192 girls and 335 boys were considered in this study excluding the staccato/interrupted voiding pattern or voided volume less than 20 ml. The voiding volume, the maximum and average urinary flow rates were extensively analyzed.

Results

The maximal and average urine flow rate nomograms were plotted for both girls and boys. Mean maximum urine flow rate was 19.9 (ml/sec) for boys and 23.5 (ml/sec) for girls with a mean voided volume of 142 (ml) for boys and 147 (ml) for girls. Flow rates showed a close association with voiding volume in both sexes. The maximum and average flow rates were higher in girls than in boys, and they showed a significant increase in flow rates with increasing age, where boys did not. The mean maximum urine flow rates (19.9 ml/sec for boys and 23.5 ml/sec for girls) were found to be higher in this study than other studies.

Conclusion

Nomograms of maximal and average flow rates of girls and boys are presented in centile form, which can help the physician to evaluate the response to medical or surgical treatment and be useful for the screening of lower urinary tract disturbances in children, for a wide range of voided volumes.     

Body surface related flow rate nomograms in a normal pediatric population

Uroflow studies for 511 normal pediatric subjects (272 boys, 239 girls) were analyzed statistically. Nomograms relating peak flow to volume voided and body surface were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. Body surface area was found to be a more reliable index than age in the establishment of nomograms. In the male population the 90% probability applied to a significantly greater volume voided reliability. In the female population mean peak flow rate rose with increased body surface. Finally, in both sexes the 10% lower limit was closer to the regression mean, allowing a tighter distribution around this value.     

Outpatient biofeedback relaxation of the pelvic floor in treating pediatric dysfunctional voiding: a short-course program is effective

INTRODUCTION: We report the treatment results of a short course of biofeedback relaxation of the pelvic floor (BRPF) in treating children with dysfunctional voiding. MATERIALS AND METHODS: Fourteen girls and 6 boys with videourodynamically proved dysfunctional voiding were enrolled. To increase the awareness of the abnormal voiding pattern, the anatomy of the pelvis and the results of a voiding diary and videourodynamics were extensively explained to the patients/parents. Surface electromyography and uroflowmetry were used as biofeedback tools to teach the adequate relaxation of the pelvic floor during voiding. The child was asked to practice the relaxation technique at home at least twice a day. BRPF was performed once a week until the child had 2 consecutive normal bell-shaped uroflow recordings. Patients were reevaluated at 4, 8, 12 and 24 weeks after BRPF training. RESULTS: The mean patient age was 8.3 +/- 3.8 years. The mean number of BRPF training sessions was 2.2 +/- 0.9. The mean follow-up period was 18.9 months. Normalization of abnormal uroflowmetry was achieved in 18 patients (90%). The mean maximal uroflow rate and voided volume increased from 13.3 +/- 4.3 to 18.0 +/- 3.4 ml/s (p < 0.01) and from 138 +/- 56 to 193 +/- 65 ml (p < 0.01), respectively. The postvoiding residual urine decreased from 54.5 +/- 47.6 to 21.3 +/- 10.6 ml (p < 0.01). Complete and partial resolution of voiding symptoms was achieved in 14 (70%) and 6 patients (30%), respectively. Recurrence was noted in 2 of the 10 patients who had complete resolution of symptoms and who had been followed up for more than 6 months. CONCLUSIONS: Short-course outpatient BRPF is an effective treatment of pediatric dysfunctional voiding.     

Flow rate nomograms in 7- to 16-year-old healthy children

To construct flow rate nomograms for children, 180 healthy boys and girls aged 7–16 years were examined with a new kind of flowmeter. Each child presented at least two registrations. The flow rate was significantly higher at the second examination and these micturitions were used to construct the nomograms. The relation between flow rate and volume may be described by the function flow = b volume^c, where b and c describe the slope and curvature, respectively. The advantages of using this relation are that non-parametric statistics can be employed, the variation around the median increases with increasing volume, and it is easy to calculate volume corrected flow rates. The exponent 0.5, often used earlier, was found to overestimate flow rates obtained at low volumes. In the constructed nomograms, the exponent varied between 0.29 and 0.42. The volume corrected maximum flow rate was about 2 ml/s higher in girls than in boys. This difference was significant. The difference of about 1.5 ml/s in average flow rate was not significant. The flow rate increased significantly with age. For volume corrected flow rates, there was, however, no significant change with age. Thus, the increase in flow rate with age is secondary to an increase in voided volume. As a result of these analyses, four nomograms were constructed showing the maximum and average flow rates for boys and girls separately. The flow rates of the new nomograms are on a level with or somewhat higher than the flow rates in previously presented nomograms for both children and young adults. © 1994 Wiley-Liss, Inc.     

A modified biofeedback program for children with detrusor-sphincter dyssynergia: 5-year experience

PURPOSE: We reviewed our 5-year experience with a modified 4 to 6-session biofeedback program combining noninvasive urodynamic approaches with various psychological techniques, including externalizing the voiding problem, empowerment and praise, to treat children with detrusor-sphincter dyssynergia. MATERIALS AND METHODS: Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. Initially normal and abnormal voiding were explained in a unique way and the children observed relaxation and contraction of the pelvic floor muscles while visualizing the electromyography monitor. The bladders were filled naturally and surface electrodes were placed. Psychological strategies were used to engage and motivate the children to achieve maximal cooperation. The children voided while attempting relaxation and post-void residual urine volume was measured by bladder scan. Special and specific praise was provided for progress and increasing self-esteem. Patients returned monthly to review these concepts and practice voiding. RESULTS: Of 87 children 77 completed the program, including 7 boys and 70 girls 3 to 17 years old (mean age 7.8) who required an average of 4.7 sessions (median 4). Results were achieved within 6 sessions in 82% of cases. Of the 77 children 59 (76%) had recurrent urinary tract infections, 38 (49%) had associated bladder instability, 19 (24%) had vesicoureteral reflux and 44 (58%) had constipation. Subjectively 47 patients (61%) reported pronounced improvement in urinary symptoms, while another 24 (32%) reported moderate improvement after biofeedback training. Objectively 47 children (61%) had normal flow with minimal electromyography activity during voiding and a normal post-void residual urine of less than 20% voided volume (p <0.002). In 28 cases (36%) flow studies improved (p <0.03) but post-void residual urine remained elevated. Vesicoureteral reflux resolved in 9 cases after biofeedback training. This approach was equally successful in children in all age groups. Those with more than a 2-year history of symptoms, poor bladder emptying and severe constipation had only moderate improvement. CONCLUSIONS: The modified biofeedback program including appropriate explanations and psychological approaches appeared effective for treating 92% of children with detrusor-sphincter dyssynergia. It is less invasive and requires less time than traditional methods, and patients are more compliant with treatment.     

Additional effect of propiverine for naftopidil-resistant nocturia in the patient with benign prostate hypertrophy

The efficacy and safety of additional administration of propiverine were prospectively studied for naftopidil-resistant nocturia in patients with benign prostatic hypertrophy (BPH). Patients of 50 years and over with BPH who experienced nocturia twice a night or more and an overall International Prostate Symptom Score (IPSS) of 8 or more were first administered naftopidil (50 or 75 mg/day) for 4 weeks. Thirty subjects who did not show improvement in nocturia and requested further treatment were enrolled in the present study. Propiverine was then administered concomitantly 10 mg/day for 8 weeks. Significant improvement was observed with additional propiverine in the frequency of nocturia on voiding diary, total IPSS, voiding symptom, storage symptom and nocturnal voiding scores. No significant change was observed in the peak urinary flow rate (Qmax), mean urinary flow rate (Qave), voided urine volume, or residual urine volume. Adverse events were dysuria (2 cases), increased residual urine (6 cases), weak urine flow (1 case), thirsty (2 cases), angular cheilitis (1 case). Administration of propiverine was suspended in 7 subjects, 1 following dysuria and 6 following increased residual urine volume. The suspension of propiverine following increased residual urine volume was significantly more prevalent in subjects with pretreatment Qmax values of less than 10 ml/second or in subjects whose prostate specific antigen (PSA) levels were 2 ng/ml or more. In conclusion, the results indicate that additional administration of propiverine may be useful for the patients with BPH who have naftopidil-resistant nocturia. However, caution must be exercised regarding Qmax and PSA levels.     

Renal net acid excretion related to body surface area in children and adolescents

Renal net acid excretion (NAE) was determined in 2307 24-h urine samples from 566 healthy children and adolescents (285 boys, 281 girls; 2.7–18.3 years) participating in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study. NAE is presented for 32 different age and sex groups. Before puberty there is an age-dependent increase in absolute values of NAE (mmol/day) and an age-dependent decrease in NAE related to body weight (mmol/kg per day). NAE related to body surface area (mmol/day per 1.73 m²) was independent of age with higher values in boys than in girls. In summary, body surface area is an appropriate adjustment parameter for renal NAE in the age-independent assessment of the renal acid load in German children and adolescents. Received: 12 November 1999 / Revised: 15 March 2000 / Accepted: 17 April 2000     

Total body water volume for white children and adolescents and anthropometric prediction equations: the Fels Longitudinal Study

BACKGROUND: There are few studies of total body water (TBW) volume in children. Such studies are needed, as are new prediction equations for the clinical management of children with renal insufficiency and those receiving dialysis. METHODS: Mixed longitudinal data were from 124 white boys and 116 white girls 8 to 20 years of age. TBW volume was measured by deuterium nuclear magnetic resonance spectroscopy, and random effects models were used to determine patterns of change over time. Sex-specific TBW prediction equations were developed using regression analysis. RESULTS: Boys had significantly greater (P < 0.05) mean TBW volumes than girls at all but 3 ages. TBW was significantly (P < 0.05) associated with age and maturation in the boys and the girls. In boys, mean TBW/WT varied from 0.55 to 0.59, while in the girls the mean declined from 0.53 to 0.49 by 16 years of age. Boys had significantly larger means for TBW/WT than girls, who had a significant, slight negative trend with age. The prediction equations were TBW = -25.87 + 0.23 (stature) + 0.37 (weight) for boys and TBW =-14.77 + 0.18 (stature) + 0.25 (weight) for girls. CONCLUSION: Means are provided for TBW in white children from 8 to 20 years of age, whose average fatness affected the percentage of TBW in body weight. These updated TBW prediction equations perform better than those available from the past.     

Age related flow rate nomograms in a normal pediatric population

Uroflow studies in a normal pediatric population were analysed statistically. Single studies for 511 subjects (272 boys and 239 girls) were reviewed. Nomograms relating peak flow to volume voided and age were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. The mean values of peak flow rate increased with volume voided in both sexes and also with age in the male population. Different sets of nomograms, which are necessary for daily clinical evaluation, are given. They define the normal values in the normal population.