正常儿童Staccato尿流曲线分析

目的　探讨正常儿童staccato尿流曲线的发生率和尿流率表现。方法　对 16 9例无下尿路症状儿童 (男 81例 ,女 88例 ,年龄 8～ 13岁 ,平均 10 .3± 1.6岁 )进行自由尿流率检测 ,并用B超测量残余尿量。全部儿童尿量均大于 5 0ml。对其中表现为Staccato尿流曲线的儿童的检查结果进行回顾性分析。结果　 8～ 13岁正常儿童Staccato尿流曲线的总体发生率为 31.9% ,其中男 2 9.6 % ,女 34.1% ,二者之间无显著性差异。随着年龄增长男性发生率逐渐下降 ;女性发生率与年龄无相关性。Staccato尿流曲线的发生率受尿量影响 ,随尿量增加而增加。男性最大尿流率 ( 2 6 .9± 10 .5 )ml/s ,平均尿流率 ( 13.2± 4 .1)ml/s,尿量 ( 198.2± 118.7)ml,残余尿发生率 12 .5 % (残余尿量均小于 5ml) ;女性最大尿流率 ( 2 5 .9± 9.3)ml/s,平均尿流率 ( 13.1± 4 .9)ml/s,尿量 ( 2 4 3.7± 16 4 .0 )ml,残余尿发生率 6 .7% (残余尿量均小于 5ml)。Staccato尿流曲线儿童尿量、尿流时间和达最大尿流时间均显著大于正常尿流曲线儿童 ;最大尿流率、平均尿流率和残余尿发生率与正常尿流曲线儿童无显著性差异。结论　正常小儿的Staccato尿流曲线常见 ,其发生率受年龄大小和尿量多少影响。如果发现小儿Staccato尿流曲线应结合残余尿是否     

小儿膀胱输尿管反流87例相关尿动力学因素研究

目的 探讨小儿膀胱输尿管反流(vesicoureteric reflux,VUR)的尿动力学表现特点,为小儿VUR的诊断和治疗提供临床参考.方法 选取在郑州大学第一附属医院小儿尿动力学中心就诊的VUR患儿87例(男58例,女29例);年龄4～12岁,平均6岁.另选取因下尿路症状就诊而尿动力学检查无异常且无VUR小儿60例(男38例,女22例)作为对照组;年龄4～12岁,平均6岁.将VUR患儿依据反流的程度分为轻度(Ⅰ度,15例)、中度(Ⅱ度和Ⅲ度,33例)、重度(Ⅳ度和Ⅴ度,39例).尿动力观察参数包括:最大尿流率、残余尿量、最大逼尿肌收缩压力、最大膀胱容量和膀胱顺应性.结果 VUR组的最大尿流率和最大膀胱容量分别为(6.8±6.3)ml/s和(138.5±73.9)ml,均明显低于对照组(16.1±6.7)ml/s和(285.5±107.5)ml,组间比较,差异有统计学意义(P＜0.05).VUR组残余尿量为(95.9±103.4)ml明显高于对照组(9.6±13.9)ml,差异有统计学意义(P＜0.05).VUR组最大逼尿肌压力为(41.6±22.2)cmH2O与对照组(35.1±13.0) cmH2O比较,差异无统计学意义(P-0.229).VUR组男、女童尿动力学参数差异无统计学意义(P＞0.05).VUR组轻度反流(15例)、中度反流(33例)和重度反流(39例)的最大膀胱容量分别为(121.83±69.94) ml、(163.73±80.81)ml和(123.58±68.70) ml,组间比较,差异无统计学意义(P＞0.05).轻度反流组顺应性正常12例(80％),中度反流组12例(36.4％),重度反流组9例(23.1％),三组间差异有统计学意义(P＜0.05).结论 最大尿流率降低、最大膀胱容量减少、残余尿量增多和膀胱顺应性差可能是VUR发生的相关因素.     

305例原发性遗尿症儿童尿流率检测结果分析

目的通过分析尿流率检测结果评价原发性遗尿症患儿的膀胱尿道功能。方法选择2001年10月￣2005年8月在我院尿动力学室进行尿流率检测的原发性遗尿症患儿。患儿先饮水,待有强烈尿意时,在不受干扰的环境中采取自然体位排尿于尿流率测量仪器上。记录最大尿流率、平均尿流率、排尿时间、尿流时间、尿量、达峰时间及尿流曲线等,同时于肛门口贴电极片同步测量盆底肌募集肌电图。结果原发性遗尿症患儿共305例,男183例,女122例。平均年龄8.4±0.3岁(5～18岁)。白天有尿频、尿急、湿裤症状的复杂性遗尿病例225例,占73.8%;单症状性夜间遗尿病例80例,占26.2%。88.2%的患儿有效膀胱容量减小,其中单症状性夜间遗尿患儿中,82.1%存在有效膀胱容量减小,而复杂性遗尿患儿中90.0%有此现象,二者相比,差异有统计学意义(P<0.05)。7～14岁女孩最大尿流率平均为19.7±1.2ml/s,明显小于正常(P<0.05),男孩为18.6±1.1ml/s。尿流率曲线中钟形曲线占54.8%;Staccato排尿曲线占12.5%;间断排尿曲线占7.2%;功能性膀胱出口梗阻形曲线占14.4%。128例(占42.0%)患儿排尿时出现收缩的肌电图信号。结论通过尿流率分析发现部分原发性遗尿症患儿存在膀胱尿道功能异常,表现为有效膀胱容量减小、最大尿流率降低和逼尿肌-括约肌收缩不协调等。与尿动力学检查相比,尿流率检测无创易行,值得在原发性遗尿症儿童中进行。     

小儿后尿道瓣膜切除后合并排尿异常的尿动力学研究

目的 探讨经尿道镜后尿道瓣膜切除术后伴有排尿异常患儿上尿路、膀胱功能及预后.方法 回顾性分析2002年7月至2012年2月收治的行尿道镜电灼后尿道瓣膜术后获得随访的58例患儿的病例资料,归纳总结其存在的临床症状、影像学异常以及尿动力学检查结果,并将其分为排尿正常组(10例)和排尿异常组(48例),对其年龄分布、上尿路情况、尿动力学参数进行比较分析.结果 术后仍存在的临床症状有:尿失禁18例(31.0％),反复泌尿系感染8例(13.8％),排尿费力、滴尿15例(25.9％),尿频4例(6.9％),尿不尽5例(8.6％),无明显症状10例(17.2％),肾功能衰竭3例(5.2％).影像学检查示:术后仍存在双肾积水者50例91侧(86.2％),存在膀胱输尿管反流23例27侧(39.7％).58例患儿中56例(96.6％)存在不同程度的尿动力学异常.逼尿肌不稳定者占16例(27.6％％);逼尿肌收缩无力者6例(10.3％);残余尿量＞10 ml者25例(43.1％);腹压参与排尿者23例(39.7％).比较排尿正常组与排尿异常组单侧肾输尿管积水比例(11.1％ vs 88.9％)、双侧肾输尿管积水比例(9.8％ vs 90.2％)、单侧膀胱输尿管反流比例(6.7％ vs 93.3％)、双侧膀胱输尿管反流比例(12.5％ vs 87.5％),差异均具有统计学意义(P＜0.05).排尿正常组与排尿异常组逼尿肌漏尿点压力[(29.1±5.5)CmH2O vs (50.4±4.8)CmH2O]、膀胱顺应性[(12.1±3.8)ml/cmH2O vs (4.0±0.1)ml/cmH2O]、残余尿量比较[(21.3±8.1)ml vs (45.7±9.6)ml],差异均有统计学意义(P＜0.05).结论 后尿道瓣膜患儿解除梗阻后多数患儿仍存在不同程度膀胱功能问题,排尿异常组膀胱功能及上尿路情况明显差于排尿正常组.后尿道瓣膜患儿术后应注意排尿情况,定期做尿动力学检查,对症处理,以更好的保护肾功能.     

间置尿道成形术治疗特殊形态阴茎头型尿道下裂和单纯性严重阴茎弯曲北大核心CSCD

目的探讨间置尿道成形术在特殊形态阴茎头型尿道下裂和单纯性严重阴茎弯曲中的应用价值。方法回顾性分析2008年11月至2019年12月在深圳市儿童医院实施间置尿道成形术治疗的特殊形态阴茎头型尿道下裂伴严重弯曲(>30°)或伴阴茎体段尿道菲薄者9例和单纯严重阴茎弯曲畸形(>30°)2例患儿的临床资料。患儿初次手术年龄25-109个月,中位年龄40个月。手术方法包括:不分期间置尿道成形术2例,分期间置尿道成形术9例。术后随访8个月-12年,随访内容包括阴茎形态、排尿情况,有无尿瘘、尿道狭窄和检测尿流率。尿流率数据以±s表示,组间比较采用t检验。结果术中间置尿道长度为2.2-4.2 cm,平均长度3.2 cm。术后随访阴茎无弯曲,排尿顺畅且尿线不分叉,阴茎外形满意。并发尿瘘2例,其中分期和不分期手术各1例,经再次手术修复成功;无尿道狭窄和尿道憩室患儿。最大尿流率术后3个月为(8.3±1.0)mL/s、6个月为(6.7±1.9)mL/s,与健康对照组[(12.3±3.0)mL/s]比较,差异有统计学意义(t=3.221、3.864,均P<0.05),而术后1年最大尿流率[(10.5±3.7)mL/s]与健康对照组比较,差异无统计学意义(P>0.05)。结论间置尿道成形术治疗儿童轻微的阴茎头型尿道下裂同时伴严重阴茎弯曲和/或阴茎体段尿道发育不良者及严重阴茎弯曲畸形是一种行之有效的手术方式。     

遗尿患儿初始尿意与强烈尿意时尿流率及残余尿测定分析

目的分析遗尿患儿在初始尿意和强烈尿意两种不同情况下尿流率和残余尿测定结果的差异,为临床应用尿流率测定来判断遗尿患儿膀胱功能提供参考。方法对来本院就诊的102例原发性遗尿症患儿(男性60例,女性42例),在初始尿意和强烈尿意时分别进行尿流率和残余尿测定,比较两种情况下尿流率参数(排尿量、排尿时间、最大尿流率)及每次残余尿量检查结果。结果初始尿意时测得患儿最大尿流率为(15.5±8.2)m L/s,残余尿量为(2.9±5.9)m L;强烈尿意时测得患儿最大尿流率为(19.9±9.7)m L/s,残余尿量为(5.2±6.9)m L;初始尿意与强烈尿意下最大尿流率和残余尿比较,差异均有统计学意义(P0.05)。最大尿流率随尿量的增加而增加,但当尿量增加到一定程度后最大尿流率反而有下降趋势。男性与女性在初始尿意时的最大尿流率和残余尿没有显著差异,但在强烈尿意时,男性的最大尿流率显著低于女性,(18.5±8.2)m L/s vs(24.2±12.5)m L/s(P0.05),而残余尿量没有差异。结论遗尿患儿在初始尿意和强烈尿意下尿流率-残余尿测定结果有显著差异,遗尿患儿进行自由尿流率测定时不宜过度憋尿,临床上分析尿流率及残余尿测定结果时要考虑尿意状态和排尿量对尿流测定参数的影响。     

尿动力学评估小儿尿道外伤Ⅱ期尿道成形术疗效的意义

目的　探讨尿动力学测定在评估小儿尿道外伤后Ⅱ期尿道成形术疗效的意义。方法　4 1例小儿尿道外伤后行Ⅱ期尿道成形术 (男 32例 ,女 9例 ,年龄范围 3～ 17岁 ,平均 10± 4岁 ) ,外伤后 3～ 9个月 ,平均 6 .5个月。分为第 1组 16例 ,行内窥镜尿道成形术 ;第 2组 2 5例 ,行经会阴尿道成形术 ;术后 1个月行自由尿流率测定和膀胱压力流率测定 ,记录尿流率 (Qmax)、自由排尿量 (VV)、残余尿量 (PVR)、最大尿流率时逼尿肌压力 (PdetatQmax)和A/G值。对照组 10例 (男 7例 ,女 3例 ,年龄范围 3～ 12岁 ,平均 8± 4岁 ) ,因上尿路疾病需要手术治疗而下尿路功能正常。结果　Qmax、VV、PVR、PdetatQmax和A/G在第Ⅰ组、第Ⅱ组和对照组之间的差异无统计学意义 (P >0 .0 5 )。P Q图示第Ⅰ组 13例位于非梗阻区、1例位于可疑梗阻区、2例位于梗阻区 ;第Ⅱ组 2 0例位于非梗阻区、1例位于可疑梗阻区、4例位于梗阻区。二组位于非梗阻区的差异无统计学意义 (P >0 .0 5 )。结论　掌握好适应证 ,内窥镜尿道成形和经会阴开放尿道成形术均可达到治疗目的。小儿尿动力学测定可以评估小儿外伤后Ⅱ期尿道成形术后的尿道功能 ,帮助早期发现尿道狭窄。     

Efficacy of holmium laser combined with transurethral electroic incision in children with urethral stricture

目的 探讨钬激光尿道内切开术联合瘢痕电切术治疗小儿尿道狭窄的疗效及安全性.方法 对2009年4月至2011年4月收治的48例男性尿道狭窄的患儿,进行钬激光尿道内切开术联合瘢痕电切术,年龄2～15岁,平均5.2岁;病程1个月至2年,平均5个月.记录尿失禁、尿外渗及继发出血等并发症发生情况和狭窄复发率,并联合超声尿流率测定评估疗效和进行为期1年随访.结果 患儿手术均顺利,无尿失禁、尿外渗,无继发出血等并发症.拔尿管后2周随访时,最大尿流率和平均尿流率分别为(18.5±4.3)ml/s和(10.4±3.7)ml/s,均显著高于术前(5.2±2.1)ml/s和(3.8±0.7)ml/s,尿流时间为(10.9±4.9)s,显著低于术前(14.6±4.2)s,差异有统计学意义;但8例(16.7％)尿流率测定仍提示尿道梗阻,其中6例进行定期扩张尿道,2例再次钬激光尿道内切开术治疗后定期扩张尿道.共计44例(91.7％)完成1年随访,一次性治愈率达83％.结论 钬激光尿道内切开术联合瘢痕电切术具有微创、术后复发率低的优点,是治疗小儿尿道狭窄安全有效的方法之一;尿流率测定有助于术后早期鉴别再次尿道狭窄患儿.     

小儿尿动力学评价参数的选择

目的 通过评价小儿下尿路尿动力学检测中常用评价参数的临床符合率。探讨各参数的可靠性。方法 参照ICCS小儿下尿路尿动力学检测和评价标准。评价尿流率、膀胱内压测定、压力／流率／EMG检测等各项参数，计算尿动力学结果与临床症状之间符合率。结果 325例中，检测结果可用于分析者为317例(97．5％)。均完成尿流率、膀胱内压和尿道压力分布检测，164例(50．5％)完成压力／流率／EMG检测。尿流曲线、膀胱容量、顺应性、稳定性的临床符合率高，分别为Lj3．7％、99．1％、92．1％和96．8％，其余参数的符合率均较低。结论 选择尿流曲线参数筛查小儿是否存在下尿路梗阻的可靠性相对较好。用于评价充盈期膀胱储尿功能的各参数中，除膀胱感觉外，均有较好的可靠性。尿道压力参数的可靠性较差。在小儿中检测排尿期压力／流率／EMG较难完成．其结果的可靠性差。     

前尿道瓣膜切除术后膀胱功能异常与上尿路损害的关系

目的探讨前尿道瓣膜切除术后造成上尿路持续损害的尿动力学危险因素。方法回顾性分析2007年1月至2020年1月26例前尿道瓣膜切除术后患儿的临床资料,平均年龄3.4岁(5个月至14岁)。瓣膜切除术后4个月至12.5年,平均5.5年。患儿术后均进行尿动力学检查。手术前后均进行血生化(包括尿素氮、肌酐)检查、泌尿系统B超检查、静脉肾脏造影(intravenous pyelography,IVP)和排尿性膀胱尿道造影(voiding cystourethrogram,VCUG)。比较瓣膜切除前后肾和输尿管积水以及膀胱输尿管反流情况,分析造成前尿道瓣膜术后上尿路持续损害的危险因素。结果前尿道瓣膜切除手术前肾和输尿管积水患儿共15例24侧,占57.7%(15/26);膀胱输尿管反流8例11侧,占30.8%(8/26)。瓣膜切除术后有5例7侧肾和输尿管积水消失,占19.2%(5/26);2例3侧膀胱输尿管反流消失。瓣膜切除术后肾和输尿管积水患儿共10例17侧,占38.5%(10/26);膀胱输尿管反流6例8侧,占23.1%(6/26)。有7例11侧肾和输尿管积水较术前加重,占26.9%(7/26),其中4例6侧膀胱输尿管反流较术前加重。根据术后肾和输尿管积水以及膀胱输尿管反流恢复情况,分为上尿路损害加重组(7例)和上尿路损害减轻或消失组(19例)。行瓣膜切除术后尿动力学检查发现,在上尿路损害加重组7例患儿中,压力流率图显示5例依然存在下尿路梗阻或可疑梗阻。上尿路损害减轻或消失组19例患儿压力流率图均显示无梗阻(P<0.05);两组最大尿流率平均值、膀胱顺应性、排尿期最大逼尿肌压力值差异均存在统计学意义(P<0.05);上尿路损害加重组中5例动态VUCG显示排尿时膀胱颈全程开放不全,行膀胱尿道镜检查发现3例膀胱壁增厚,呈小梁样改变和膀胱假性憩室形成,尤其膀胱基底以及膀胱内口附近组织明显增厚。结论前尿道瓣膜是一种罕见的下尿路梗阻性疾病,瓣膜切除之后上尿路损害仍然会持续存在或加重,可能与患儿异常的膀胱功能有关。排尿期最大逼尿肌压力升高、最大尿流率低、膀胱顺应性低以及压力流率图显示梗阻仍存在是导致膀胱功能异常的尿动力学危险因素,可能与前尿道瓣膜患儿同时存在膀胱颈部功能与结构的异常有关。     

主动分期尿道下裂修复术的临床研究及近期尿动力学评估

目的 探讨分期手术治疗重型尿道下裂的价值.方法 回顾性分析2011年8月至2015年3月33例重型尿道下裂分期手术的临床效果及尿道功能的尿动力学评估资料,同时选取年龄相当的无尿道疾病住院患儿作为正常对照组进行对比分析.本组年龄2岁5个月～11岁,随访最长32个月.一期手术矫正下曲后按Barcat分型均为后型.二期手术术式主要有Duplay、Snodgrass、Thiersch,还有改良Koyanagi或Onlay.两期手术间隔8～16个月,平均12个月.成形尿道长度平均4.5cm.分别于术后1个月及6个月2个时段行尿流率检查,测量最大尿流率、排尿时间、排尿量、Qc值,评估尿流曲线,并与正常对照组对比.按照Qmax低于正常对照组均数的2个标准差定义为梗阻尿流.结果 本组术后均无阴茎弯曲,正位尿道口31例,尿道外口退缩2例;尿瘘8例(24.2％);无尿道狭窄患儿.术后1个月时,梗阻型尿流和非梗阻型尿流分别占53.0％(9/17)和47.0％(8/17);而术后6个月时段对应值为46.2％(6/13)和53.8％(7/13),比较构成比,差异无统计学意义.术后1个月时段梗阻型尿流曲线(平台曲线、不规则曲线)和非梗阻型尿流曲线构成比分别为76.5％(13/17)和23.5％(4/17),术后6个月时段则分别为76.9％ (10/13)和23.1％(3/13);正常对照组为10.6％(7/66)和89.4％ (59/66).术后2个时段梗阻型尿流曲线的比例均高于正常对照组,且差异有统计学意义(P＜0.05);而术后2个时段比较差异无统计学意义.结论 主动选择性分期手术修复重型尿道下裂,尿瘘发生率较高,但并发尿道狭窄风险极低;尿流率测定结果显示术后半年内尿道功能呈现功能性梗阻.     

Intermediate-term functional and cosmetic results of the Snodgrass procedure in distal and midpenile hypospadias

We have evaluated the long-term functional and cosmetic results of the Snodgrass technique in the treatment of anterior and midpenile hypospadias. A total of 70 patients who presented in the period between 1997 and 2002 underwent the Snodgrass procedure for the treatment of hypospadias. Patients who had been operated on 2 or more years previously were recalled for evaluation. Of the 31 cases identified, 19 (61%) were contacted and came for reevaluation. Genital examination and urinary flow measurements were made. Maximum urinary flow rates and voided urine volumes were assessed using the nomograms described by Toguri et al. The mean age of the patients was 6 years (range 2–12) at the time of surgery and 8 years (range 4–17) at the time of evaluation, and the mean follow-up period was 3.1 years (range 2–5). Two patients had had at least one previous surgery, and 17 were primary patients. The hypospadiac meatus was anterior in 16 patients and midpenile in three. Although some patients had urinary spraying due to skin irregularity in the meatus during voiding, 18 patients had normal peak urinary flow rate (Qmax) corresponding to their age group. Only one patient in the equivocally obstructed group had meatal stenosis, which was corrected with meatotomy. All patients had a cosmetic view of a vertical slit tip of the glans. Tubularized incised plate urethroplasty (TIPU) is a successful technique with good functional and cosmetic long-term results in distal hypospadias.     

前型尿道下裂患儿尿道口前移龟头成形术后尿道功能的评估

目的探讨尿道口前移龟头成形术（MAGPI）对前型尿道下裂患儿尿道功能的影响。方法2008年8月到2011年8月作者收治16例男性前型尿道下裂患儿,年龄2—10岁,平均4岁9个月,其中龟头型2例（12．5％）,冠状沟型14例（87．5％）;8例（50．0％）伴轻度阴茎下弯。依据Duckett报道的手术方法对16例患儿行MAGPI手术治疗。术前术后行尿流率检查。结果患儿均一次手术获成功。术后2～3个月尿流率检查提示最大尿流率、平均尿流率术前术后比较,均有统计学意义,最大尿流率由术前的（9．5±2．7）mL／s增加到术后（11．6±2．0）mL／s（P=0．022）;平均尿流率（6．2±1．6）mL／s增加到术后（7．7±1．4）mL／s（P=0．009）。结论MAGPI手术方法简单,成功率高,术后无尿道狭窄发生,患儿尿道功能较术前改善,对于合适的前型尿道下裂患儿是一种很好的手术方法。     

Analysis of uroflow patterns in children with dysfunctional voiding

ObjectiveAlthough a staccato uroflow pattern is considered representative of dysfunctional voiding (DV), we recently found that only a third of children with staccato flow had an active pelvic floor electromyography (EMG) during voiding. Here, we analyzed the reverse, that is, how often a staccato flow pattern occurs in children with documented DV. In addition, we reviewed what other flow patterns are prevalent in this condition.Materials and methodsWe reviewed our LUT dysfunction registry for children with EMG-confirmed DV. Uroflow patterns were categorized as staccato, interrupted, mixed (i.e., staccato and interrupted patterns), or grossly normal.ResultsOf 596 children who underwent a uroflow/EMG examination, 121 had an active pelvic floor EMG during voiding, that is a finding consistent with the diagnosis of DV. The flow patterns identified in those diagnosed with DV were staccato in 70 (58%), interrupted in 22 (19%), mixed in 12 (10%), and a bell-shaped or depressed curve in 17 (14%). Staccato pattern became normal in 96% following successful treatment with biofeedback.ConclusionsWhile a staccato uroflow pattern was the most common pattern seen in children diagnosed with DV by a uroflow/EMG, nearly a third had an interrupted or mixed flow pattern underscoring the importance of performing simultaneous pelvic floor EMG during a uroflow study, especially when trying to rule out DV. Failure of the staccato flow pattern to normalize after therapy strongly suggests either inadequate therapy or an incorrect diagnosis.     

Uroflowmetry in children--is it necessary to repeat the study in a single patient?

Uroflowmetry, as the only non-invasive urodynamic means of assessing the function of the lower urinary tract is widely used in children. A possible psychological influence on the results is the reason why uroflowmetry is often repeated in the same patient. OBJECTIVES: The investigation was conducted to compare parameters of repeated uroflowmetry in a single child with the results of single uroflowmetry performed in a group of children. The goal of the study was to evaluate the efficacy of a single uroflow procedure in children. MATERIAL AND METHODS: A single uroflowmetric study was performed in 44 children aged from 9 - 11 years (mean 10 yrs). Out of the group one child was chosen who had 32 successive uroflow attempts. The range and average values of the uroflowmetric parameters were compared in both groups. Pearson's correlation coefficient was used for calculation and for a comparison of the uroflowmetric parameters of both groups (significance level p < 0.05). RESULTS: Average values of the voided volume, maximal and average flow were lower in the 32 attempts of a single child than in the control group (44 attempts). The values of the Pearson's correlation coefficient were ranged from 0.2 to 0.4 for flow/voided volume ratio and from 0.4 to 0.8 for flow time/voided volume ratio in both groups. There were no differences between the values in both groups apart from flow time/voided volume correlation (significance level p < 0.05). CONCLUSION: Repetition of uroflowmetric study does not seem to improve the efficacy of the modality in assessing voiding function in children.     

出生1～7 d早产儿12 h自由排尿观察

目的 探讨出生7 d内早产儿的自由排尿特点.方法 选取2010年3-5月在本院NICU住院的113例出生7 d内无疾病的单胎早产儿.男60例,女53例;胎龄32～36周[(34.0±1.9)周];体质量1.16～2.07 kg[(1.48±0.34) kg].据日龄分为7组(第1天组～第7天组).第1天组6例,第2天组11例,第3天组11例,第4天组18例,第5天组18例,第6天组26例,第7天组23例.每组均进行12 h(900-2100)自由排尿观察,记录排尿时间、每次排尿量, B超测量排尿后残余尿量,排尿时觉醒状态.结果 113例早产儿12 h共观察排尿745次.第1天组6例早产儿观察时段位于出生0.5～12.5 h,12 h内排尿1～4次[(2.8±1.2)次],其中5例出生4 h内无排尿.第3天组开始发现早产儿排尿前有手臂或大腿微动或排尿后啼哭现象.第2、3、4天组平均2.5 h排尿1次.第5、6、7天组平均不到2 h排尿1次.第1天组、第4天组、第7天组排尿次数、排尿量比较差异均有统计学意义(Pa<0.05).各组残余尿量比较差异均无统计学意义(Pa>0.05),膀胱排空率均低于30%.总体27.39%(204/745次)的排尿发生在清醒状态.间断排尿(10 min内排尿次数≥2)见于第2天组以后的早产儿,达70%(522/745次).结论 出生7 d内的早产儿中枢神经系统参与排尿不明显.每次排尿量及排尿次数变异较大,但有随日龄增加的趋势.     

Abnormal voiding parameters in children with severe idiopathic constipation

Objective

It is suggested that idiopathic constipation may associate with abnormal voiding parameters. In this study, we investigate the voiding parameters in children with constipation.

Methods

Since 2010, seventeen consecutive children (12 boys, 5 girls) aged 5–17 (median = 14) with significant constipation according to Rome III criteria and who were not responding to conventional treatment (diet, laxatives & bowel training) for over 6 months were recruited. The rectal diameter (RD) was measured by transpubic ultrasonography (USG), RD >3.5 cm was considered as dilated. Each patient had uroflow measurement and bladder USG done to measure the maximal flow rate (Vmax), voided volume (VV), and post-void residual urine (PVR). Abnormal voiding parameters were defined as Vmax <12 ml/sec, VV <65 or >150 % of age-adjusted expected bladder capacity (EBC) and/or PVR >20 ml.

Results

Rectal diameter ranged from 1.7 to 8.2 cm (median = 3 cm) and was abnormally dilated in eight children. Vmax was normal in all children (median = 23.7 ml/sec). Voided volume ranged from 30 to 289 % of EBC and was abnormal in six children (35.5 %). Post-void residual urine varied from 0 to 85 ml and was abnormal in six (35.5 %) children. Three children (17.6 %) had both abnormal VV and PVR. On the whole, the prevalence of abnormal voiding parameters in constipated children was 52.9 %. Mean RD in normal and abnormal parameters groups was 2.8 and 4.7 cm, respectively. Rectal dilation was associated with abnormal voiding parameters (p = 0.015).

Conclusion

Abnormal voiding parameters including voided volume and post-void residual urine are prevalent in constipated children. Dilated rectum is associated with abnormal voiding parameters.     

Uroflowmetry in the management of lower urinary tract symptoms of children and adolescents with cerebral palsy

ObjectiveTo evaluate uroflow measurements in the initial management of lower urinary tract dysfunction in children and adolescents with cerebral palsy.Materials and methodsA total of 54 patients was enrolled in this study. All patients reported their urinary symptoms and underwent a physical examination, renal and urinary tract ultrasonography, and uroflow assessment.ResultsTwenty-three patients were female. Mean age was 9 years and 6 months (SD: 2 years and 10 months), with a range of 5–18 years. Twenty-eight of the patients (51.8%) were symptomatic. Urgency (42.6%), urge incontinence (40.7%), and enuresis (16.7%) were the most frequently observed symptoms. No association was found between gender, ambulatory status, or distribution of the paralysis and uroflow parameters. Symptomatic patients presented a statistically lower maximum flow (Q_max) than asymptomatic patients (17.2 ± 7.8 ml/s vs 22.6 ± 7.5 ml/s, p = 0.013, respectively). Normal bell-shaped curves were observed more frequently in asymptomatic patients, while abnormal curves were observed more frequently in symptomatic patients (p = 0.022).ConclusionsGender, ambulatory status, and the distribution of the paralysis do not affect Q_max rate or flow pattern. Symptomatic patients present lower Q_max and may also have an abnormal uroflow curve. Uroflowmetry may be useful in the initial urological evaluation.     

前瞻性随机对照研究生物反馈和口服醋酸去氨加压素治疗儿童原发性遗尿症的疗效

目的: 通过前瞻性随机对照研究比较生物反馈和口服DDAVP两种方法对治疗原发性遗尿症（PNE）的效果。方法：将2005.7-2006.1在复旦大学附属儿科医院确诊为PNE的儿童随机分为DDAVP组和生物反馈组，进行1个月的治疗和其后3个月的随访，指标包括排尿日记，尿流率，尿液AQP2。结果：PNE患儿共50例，男26例，女24例；平均年龄8.4±0.9岁。治疗结束和结束后第3个月时生物反馈组总有效率均高于DDAVP组，两组治愈率和复发率无明显差异。生物反馈组治疗结束时最大尿流率和尿量较治疗前明显提高，正常尿流曲线和逼尿肌-括约肌收缩协调人数较治疗前明显增多。晨尿尿液AQP2主要检测到两个条带，均可见遗尿组灰度显著低于对照组。DDAVP组治疗结束时AQP2与治疗前相比有明显增加。结论：生物反馈和DDAVP均是治疗PNE的有效方法。生物反馈治疗在四个月内的总有效率高于DDAVP，值得在PNE儿童中开展使用。生物反馈治疗对改善膀胱-尿道功能紊乱有帮助，而DDAVP则可以提高尿液中AQP2水平。     

Circadian variation of voided volume in normal school-age children

Functional bladder capacity (FBC) and urine output are important variables in the management of incontinence and nocturnal enuresis. The lack of reference ranges for FBC vs. age, and the arbitrarily defined time-windows for measuring urine output, impede the clinical use of these variables in children. To solve these impediments, we had 26 girls and 28 boys, between 6 and 12 years of age, collect, measure, time, and sample every voiding, using 72-h frequency-volume charts; all samples were analysed for osmolality and creatinine concentration. Voided volumes show a very wide range (10–550 ml) and a subset that is significantly larger than all other voidings: early morning voidings (EMV). The individual maximum voided volume (MVV) belongs to the category of EMV in 74% of the children. MVV, the measure for FBC, fits the 5–95% centiles that have been published for cystographic bladder capacity for age in normal children; all other voiding are mostly below the 5% centile. Voided volume plotted vs. corresponding urine output rate shows that, with output rates below 50 ml/h, rest-phase bladder filling always results in significantly larger voidings (EMV) than activity-phase bladder filling. Two circadian rhythms seem to be involved, one for urine output, and another for inhibition of bladder contractility. With hourly population averages of individual urine and osmole output rates plotted on a time scale, circadian patterns appear; these patterns are masked when urine output is collected in blocks of 6, 8, or 12 h. Both plots are promising tools for studying the pathophysiology of voided volume vs. urine output, e.g. in children with nocturnal enuresis.