脊髓栓系的尿动力学表现及临床意义

目的：探讨及评价脊髓栓系的尿动力学表现及临床意义。方法：对66例脊髓栓系患儿行尿动力学检查、MRI和排泄性膀胱尿道造影。结果：58例患儿发现有尿动力学异常改变，逼尿肌反射亢进35例，反射低下25例，逼尿肌括约肌不协调27例。54例膀胱顺应性，逼尿肌压增加，53例 残余尿增加，51例膀胱容量减少。8例尿动力学表现正常。脊髓圆锥位置正常5例，位于L3－L5间32例，L5以下29例。输尿管反流16例。结论：脊髓栓系可导致尿动力学发生不同的异常改变，脊髓圆锥位置与尿动力学表现的类型及上尿路损害无相关关系，上尿路损害与逼尿肌括约肌不协调、逼尿肌压和患儿的年龄密切相关。尿动力学检查是评价下尿路功能和治疗的客观指标。

Urodynamic studies in tethered cord syndrome

Objective To evaluate the changes and clinical significance of urodynamic study in patients with tethered cord syndrome (TCS).Methods Sixty six patients underwent urodynamic evaluation, MRI and VCUG.Results 58 patients had abnormal urodynamic studies. Detrusor hyper reflexia was found in 33 cases, areflexia in 25 cases, detrusor sphincter dyssynergia in 27. Bladder compliance was decreased and detrusor pressure was increased in 54 cases. Residual urine was increased in 53 cases. Bladder volume was decreased in 51 cases. Eight patients had normal urodynamic studies. The position of medullary cone was normal in 5 cases, between L 3-L 5 in 32 and below L5 in 29. Vesicoureter reflux developed in 16 cases. Conclusions Patients with tethered cord have various abnormal urodynamic studies. The position of medullary cone has no correlation with urodynamic study and upper urinary tract condition. Detrusor pressure, detrusor sphincter dyssynergia and age have correlated with upper urinary tract damage. Urodynamic can evaluate the function of lower urinary tract and guide the treatment of TCS.