尿道下裂术前尿道功能的尿动力学评估

目的 探索小儿先天性尿道下裂术前尿道的功能状态及其临床意义.方法 对2～6岁尿道下裂患儿60例和正常小儿 66例进行对比研究.采用超声检查膀胱及上尿路形态;尿流率测定仪纪录尿流曲线、最大尿流率、平均尿流率、排尿量、排尿时间、尿流时间、最大尿流时间等参数;用膀胱容量测定仪测量膀胱残余尿量.结果 尿道下裂组和正常对照组小儿超声检查均未发现膀胱和上尿路形态学异常.尿道下裂组最大尿流率、平均尿流率、排尿量、排尿时间、尿流时间、最大尿流时间和残余尿量分别为(10.2±3.7)ml/s、(6.7±2.7)ml/s、(126.1±58.0)ml、(19.8±10.8)s、(19.1±10.7)s、(8.7±6.0)s、(18.9±19.3)ml.而正常对照组相应各值分别为(12.3±2.9)ml/s、(8.0±2.3)ml/s、(104.5±54.0)ml、(13.7±7.7)s、(12.6±6.7)s、(6.6±4.0)s、(12.3±12.0)ml.可见尿道下裂组最大尿流率、平均尿流率小于对照组,而排尿时间、尿流时间、最大尿流时间长于对照组,其差别均有统计学意义.尿道下裂组钟形曲线占56.7%,平台曲线占30.0%,而对照组分别为89.4%、3.0%,其差别也有统计学意义.结论 先天性尿道下裂患儿术前尿道功能异常,存在无症状的梗阻.

The urodynamic evaluation of the patients with hypospadias

Objective To study the urodynamic function of the patients with hypospadias and its clinical significance.Methods Comparative studies were performed between 60 children with hypospadias and 66 normal children.All patients aged from 2 to 6 years.All children underwent ultrasonography to examine the morphology of bladders and upper urinary tracts, uroflow ratio examination to calculate uroflow curve, maximum flow rate, average flow rate, voided volume, voiding time, flow time, maximum flow time, and bladder capacity test to determine the postvoid residual urine.Results There was no significant difference of the uhrasonic morphology of the bladders and upper urinary tracts between the hypospadias group and the normal control group.Of the patients with hypospadias,the maximum flow rate (Qmax) was 10.2±3.7ml/s, the average flow rate (Qave) was 6.7±2.7 ml/s, the voided volume was 126.1±58.0 ml, voiding time was 19.8s±10.8s, uroflow time was 19.1±10.7 s, maximum flow time was 8.7±6.0 s, and postvoid residual urine was 18.9±19.3 ml.Of the control group, the Qmax was 12.3±2.9 ml/s, the Qave was 8.0±2.3 ml/s, the voided volume was 104.5±54.0 ml, voiding time was 13.7±7.7 s, uroflow time was 12.6±6.7 s,maximum flow time was 6.6±4.0 s, and post void residual urine was 12.3±12.0 ml.Maximum flow rate, average flow rate of the hypospadias patients were significantly less than those in the control patients; while their voiding time, flow time, and maximum flow time were significantly longer than those of the control group.Of the hypospadias patients, 56.7% patients had bell-shaped uroflow curve, and 30.0% had platform uroflow curve; while 89.4% of the control group had bell-shaped uroflow curve, and 3.0% had platform uroflow curve.The difference of the uroflow curve between the 2 groups was significant.Conclusions Children with congenital hypospadias present urethra dysfunction such as asymptomatic obstruction.