urodynamics

尿动力学
  • 文章类型: Journal Article
    尿液在下尿路中的储存和周期性排尿是由包括大脑在内的复杂神经控制系统调节的,脊髓,和外周自主神经节。研究下尿路的神经调节机制有助于加深我们对尿液储存和排尿过程的理解,揭示下尿路功能障碍的潜在机制,并为相关疾病的治疗和管理提供新的策略和见解。然而,目前对下尿路神经调节机制的理解仍然有限,需要进一步的研究方法来阐明其机制和潜在的病理机制。本文就下尿路系统功能研究的研究进展作一综述,以及排尿过程中的关键神经调节机制。此外,讨论了研究下尿路调节机制的常用研究方法和评价啮齿动物下尿路功能的方法。最后,讨论了人工智能在下尿路神经调节机制研究中的最新进展和前景。这包括机器学习在下尿路疾病诊断和智能辅助手术系统中的潜在作用。以及数据挖掘和模式识别技术在推进下尿路研究中的应用。我们的目标是通过深入研究和全面了解下尿路神经调节机制的最新进展,为研究人员提供下尿路功能障碍的治疗和管理的新策略和见解。
    The storage and periodic voiding of urine in the lower urinary tract are regulated by a complex neural control system that includes the brain, spinal cord, and peripheral autonomic ganglia. Investigating the neuromodulation mechanisms of the lower urinary tract helps to deepen our understanding of urine storage and voiding processes, reveal the mechanisms underlying lower urinary tract dysfunction, and provide new strategies and insights for the treatment and management of related diseases. However, the current understanding of the neuromodulation mechanisms of the lower urinary tract is still limited, and further research methods are needed to elucidate its mechanisms and potential pathological mechanisms. This article provides an overview of the research progress in the functional study of the lower urinary tract system, as well as the key neural regulatory mechanisms during the micturition process. In addition, the commonly used research methods for studying the regulatory mechanisms of the lower urinary tract and the methods for evaluating lower urinary tract function in rodents are discussed. Finally, the latest advances and prospects of artificial intelligence in the research of neuromodulation mechanisms of the lower urinary tract are discussed. This includes the potential roles of machine learning in the diagnosis of lower urinary tract diseases and intelligent-assisted surgical systems, as well as the application of data mining and pattern recognition techniques in advancing lower urinary tract research. Our aim is to provide researchers with novel strategies and insights for the treatment and management of lower urinary tract dysfunction by conducting in-depth research and gaining a comprehensive understanding of the latest advancements in the neural regulation mechanisms of the lower urinary tract.
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  • 文章类型: Journal Article
    尿失禁是中风幸存者的常见并发症,需要新的干预措施。这项研究调查了低频(LF)重复经颅磁刺激(rTMS)对中风后尿失禁(PSI)患者对比区初级运动皮层(M1)的治疗效果。根据他们接受的干预,总共100名患者被随机分配到rTMS组或假rTMS组。两组每周进行5次治疗,共4周。来自尿动力学检查的数据被用作主要结果。次要结果指标是问卷调查和盆底表面肌电图。经过4周的干预,最大膀胱容量(MCC),最大逼尿肌压力(Pdet.max),残余尿量,膀胱过度活动症评分(OABSS)(包括频率,紧迫性,和尿失禁),与假rTMS组相比,rTMS组的ICIQ-UISF明显改善(P<0.05)。然而,PSI患者盆底肌电图无明显变化(均P>0.05)。我们的数据证实,对侧M1的4周LF-rTMS刺激在几个方面对中风后尿失禁有积极影响。比如频率,尿失禁,MCC,端部填充Pdet,OABSS,和ICIQ-UISF得分。
    Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.
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  • 文章类型: Journal Article
    背景:近几十年来,尿动力学研究(UDS)的数量一直在稳步下降,然而,这一趋势背后的原因仍然知之甚少。本研究旨在调查泌尿外科UDS的结构方面,并探讨导致这种下降的因素。
    方法:我们在2023年调查了所有执行UDS的泌尿科以及德国私人诊所的代表性样本。我们检查了结构情况,等待时间,UDS的容量和局限性。所有侵入性尿动力学检查均定义为UDS。
    结果:2019年,德国259/474(55%)泌尿科进行了UDS。206/259(80%)泌尿科对调查做出了回应。163/200(82%)泌尿科表示他们的能力已经耗尽,主要原因是缺乏医疗和护理人员。54.8%的泌尿科为转诊医师执行了50%以上的UDS。UDS/年数量低(≤100)的泌尿科显示出更短的等待时间(最多4周:49%vs.30%;p=0.01),减少UDS容量(55%与12%;p<0.001),这些容量通常没有得到充分利用(25%与9%;p=0.007)。122/280(44%)办公室泌尿科医生对调查做出了回应。18/122(15%)办公室泌尿科医师进行了UDS。不提供UDS的主要原因是缺乏人员和报销费用低。
    结论:在德国泌尿科,UDS能力始终得到充分利用,主要是由于人员短缺。这种集中化的趋势引发了人们对UDS在泌尿科医师培训中的作用的质疑。
    BACKGROUND: The number of urodynamic studies (UDS) has been declining steadily in recent decades, yet the reasons behind this trend remain poorly understood. This study aims to investigate the structural aspects of UDS in urology and explore the factors contributing to this decline.
    METHODS: We surveyed all urological departments performing UDS as well as a representative sample of private practices in Germany in 2023. We examined structural situation, waiting times, capacities and limitations of UDS. All invasive urodynamic examinations were defined as UDS.
    RESULTS: In 2019, 259/474 (55%) urological departments in Germany performed UDS. 206/259 (80%) urological departments responded to the survey. 163/200 (82%) urological departments stated that their capacities were exhausted, a main reason being lack of medical and nursing staff. 54.8% urological departments performed more than 50% of their UDS for referring physicians. Urological departments with a low number of UDS/year (≤ 100) showed a shorter waiting time (up to 4 weeks: 49% vs. 30%; p = 0.01), reduced UDS capacities (55% vs. 12%; p < 0.001) and these capacities were often not fully utilized (25% vs. 9%; p = 0.007). 122/280 (44%) office urologists responded to the survey. 18/122 (15%) office urologists performed UDS. Main reasons for not offering UDS were lack of personnel and low reimbursement.
    CONCLUSIONS: In German urological departments, UDS capacities are consistently fully utilized, primarily due to staffing shortages. This trend towards centralization prompts questions about the role of UDS in urologists\' training.
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  • 文章类型: Journal Article
    背景:诊断与膀胱出口梗阻(BOO)相关的非神经源性男性下尿路症状的根本原因具有挑战性。视频尿动力学研究(VUDS)和压力流量研究(PFS)都是BOO的侵入性诊断方法。VUDS可以更精确地区分男性BOO的病因,比如良性前列腺梗阻,原发性膀胱颈梗阻,和功能失调的排尿,可能优于PFS。
    目的:这些检查的侵入性凸显了开发非侵入性预测模型的必要性,以促进BOO诊断并减少侵入性程序的必要性。
    方法:我们对一组药物难治性男性进行了回顾性研究,2001年至2022年接受VUDS的怀疑BOO的非神经源性下尿路症状。总的来说,开发了2个BOO预测模型-1基于国际连续性协会的定义(国际连续性协会定义的膀胱出口梗阻;ICS-BOO),另一个基于视频尿动力学研究诊断的膀胱出口梗阻(VBOO)。将患者队列随机分为训练集和测试集进行分析。共有6种机器学习算法,包括逻辑回归,用于模型开发。在模型开发过程中,我们首先在训练集上使用重复的5倍交叉验证进行开发验证,然后测试验证以评估模型在独立测试集上的性能.这两个模型都实现为基于纸张的列线图,并集成到基于网络的人工智能预测工具中,以帮助临床决策。
    结果:在307例患者中,26.7%(n=82)符合ICS-BOO标准,82.1%(n=252)被诊断为VBOO。ICS-BOO预测模型在开发验证中的受试者工作特征曲线(AUC)下的平均面积为0.74(SD0.09),平均准确度为0.76(SD0.04),AUC和准确度分别为0.86和0.77,在测试验证中。VBOO预测模型的内部平均AUC为0.71(SD0.06),平均准确度为0.77(SD0.06),AUC和准确度分别为0.72和0.76,外部。当两种模型预测都应用于同一患者时,他们的综合见解可以显着增强临床决策并简化诊断途径。通过双模型预测方法,如果两个模型都正向预测BOO,提示所有病例实际上是由药物难治性原发性膀胱颈梗阻或良性前列腺梗阻引起的,可以考虑手术干预。因此,对于100名(32.6%)患者,VUDS可能是不必要的。相反,当ICS-BOO预测是负面的,而VBOO预测是正面的,表明不同的病因,建议VUDS而不是PFS用于精确诊断和指导后续治疗。准确识别51.1%(47/92)的VUDS患者。
    结论:预测ICS-BOO和VBOO的2种机器学习模型,基于6个无创临床参数,表现出值得称赞的歧视表现。使用双模型预测方法,当两个模型都有积极的预测时,可以避免VUDS,协助男性BOO诊断并减少对此类侵入性手术的需要。
    BACKGROUND: Diagnosing underlying causes of nonneurogenic male lower urinary tract symptoms associated with bladder outlet obstruction (BOO) is challenging. Video-urodynamic studies (VUDS) and pressure-flow studies (PFS) are both invasive diagnostic methods for BOO. VUDS can more precisely differentiate etiologies of male BOO, such as benign prostatic obstruction, primary bladder neck obstruction, and dysfunctional voiding, potentially outperforming PFS.
    OBJECTIVE: These examinations\' invasive nature highlights the need for developing noninvasive predictive models to facilitate BOO diagnosis and reduce the necessity for invasive procedures.
    METHODS: We conducted a retrospective study with a cohort of men with medication-refractory, nonneurogenic lower urinary tract symptoms suspected of BOO who underwent VUDS from 2001 to 2022. In total, 2 BOO predictive models were developed-1 based on the International Continence Society\'s definition (International Continence Society-defined bladder outlet obstruction; ICS-BOO) and the other on video-urodynamic studies-diagnosed bladder outlet obstruction (VBOO). The patient cohort was randomly split into training and test sets for analysis. A total of 6 machine learning algorithms, including logistic regression, were used for model development. During model development, we first performed development validation using repeated 5-fold cross-validation on the training set and then test validation to assess the model\'s performance on an independent test set. Both models were implemented as paper-based nomograms and integrated into a web-based artificial intelligence prediction tool to aid clinical decision-making.
    RESULTS: Among 307 patients, 26.7% (n=82) met the ICS-BOO criteria, while 82.1% (n=252) were diagnosed with VBOO. The ICS-BOO prediction model had a mean area under the receiver operating characteristic curve (AUC) of 0.74 (SD 0.09) and mean accuracy of 0.76 (SD 0.04) in development validation and AUC and accuracy of 0.86 and 0.77, respectively, in test validation. The VBOO prediction model yielded a mean AUC of 0.71 (SD 0.06) and mean accuracy of 0.77 (SD 0.06) internally, with AUC and accuracy of 0.72 and 0.76, respectively, externally. When both models\' predictions are applied to the same patient, their combined insights can significantly enhance clinical decision-making and simplify the diagnostic pathway. By the dual-model prediction approach, if both models positively predict BOO, suggesting all cases actually resulted from medication-refractory primary bladder neck obstruction or benign prostatic obstruction, surgical intervention may be considered. Thus, VUDS might be unnecessary for 100 (32.6%) patients. Conversely, when ICS-BOO predictions are negative but VBOO predictions are positive, indicating varied etiology, VUDS rather than PFS is advised for precise diagnosis and guiding subsequent therapy, accurately identifying 51.1% (47/92) of patients for VUDS.
    CONCLUSIONS: The 2 machine learning models predicting ICS-BOO and VBOO, based on 6 noninvasive clinical parameters, demonstrate commendable discrimination performance. Using the dual-model prediction approach, when both models predict positively, VUDS may be avoided, assisting in male BOO diagnosis and reducing the need for such invasive procedures.
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  • 文章类型: Journal Article
    这项研究的目的是评估A型肉毒杆菌毒素治疗青少年难治性膀胱过度活动症的临床有效性和安全性。回顾性分析2018年1月至2023年8月杭州市第三人民医院泌尿外科收治的37例青少年难治性膀胱过度活动症患者。这些患者接受10U/mL浓度的A型肉毒毒素膀胱内注射,平均有20个注射点。我们记录了治疗前和治疗后1个月的排尿日记和尿动力学参数的变化。治疗1个月后,在几个参数中观察到了显著的改善,当与预处理值比较时。这些包括白天排尿频率(11.13±6.45),平均单个空隙体积(173.24±36.48)mL,夜间排尿频率(2.43±0.31),紧急发作(3.12±0.27),初始膀胱容量(149.82±41.34)mL,最大膀胱容量(340.25±57.12)mL(均P<.001)。第一次治疗后,5例患者有轻度血尿,4例患者有尿路感染,1例患者有尿潴留,插管后缓解了。其他患者均未出现严重并发症或不良反应。随访时间6~18个月,疗效持续时间从2到8个月不等。最初治疗失败的八名患者在重新注射后症状缓解。在对常规药物治疗反应不佳的难治性膀胱过度活动症青少年中,A型肉毒毒素可以安全有效地给药。它显着改善了下尿路症状,并提高了这些患者的生活质量。
    The objective of this study was to assess the clinical effectiveness and safety of type A botulinum toxin in the treatment of refractory overactive bladder in adolescents. We conducted a retrospective analysis of 37 adolescent patients with refractory overactive bladder who were treated at the Urology Department of Hangzhou Third People\'s Hospital between January 2018 and August 2023. These patients received intravesical injections of type A botulinum toxin at a concentration of 10 U/mL, with an average of 20 injection points. We recorded changes in urination diaries and urodynamic parameters both before and 1 month after treatment. After 1 month of treatment, significant improvements were observed in several parameters, when compared to the pretreatment values. These included daytime frequency of urination (11.13 ± 6.45), average single void volume (173.24 ± 36.48) mL, nighttime frequency of urination (2.43 ± 0.31), urgency episodes (3.12 ± 0.27), initial bladder capacity (149.82 ± 41.34) mL, and maximum bladder capacity (340.25 ± 57.12) mL (all P < .001). After the first treatment, 5 patients had mild hematuria, 4 patients had urinary tract infection, and 1 patient had urinary retention, which was relieved after catheterization. No serious complications or adverse reactions were observed in other patients. The follow-up period ranged from 6 to 18 months, and the duration of efficacy varied from 2 to 8 months. Eight patients who initially had treatment failure achieved symptom relief after reinjection. In adolescents with refractory overactive bladder who do not respond well to conventional drug therapy, type A botulinum toxin can be administered safely and effectively. It significantly improves lower urinary tract symptoms and enhances the quality of life for these patients.
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  • 文章类型: Journal Article
    根据国际连续性协会的说法,压力性(静态)尿失禁被定义为任何不自主的尿液损失的努力或体力消耗,由于膀胱内压力克服了尿道压力,没有逼尿肌活动。尿动力学测试可准确评估膀胱和尿道的功能。尿动力学评估包括三项测试:膀胱测压,尿流图和轮廓术(尿道压力曲线的测定)。在尿动力学评估之前,必须排除尿路感染,因为这是一种侵入性检查。尿道轮廓术是一种测量尿道和膀胱在休息时的压力的技术,在紧张的行动中,在行动中。其主要目的是评估括约肌机制。在考试期间,使用了特殊的导管,从膀胱颈慢慢拉出整个尿道,连续记录尿道内压力。除了测量尿道压力,压力性尿失禁也非常成功地证明了咳嗽测试和Bonney测试。如果,关于强迫咳嗽,尿液失控地逸出,通过手指抬起膀胱的颈部来恢复节制,诊断为静态性尿失禁。在我们的泌尿妇科诊所,正在常规进行尿动力学检查。在本研究中,我们纳入了之前接受过尿失禁治疗的患者,并将他们的尿动力学评估结果与Bonney试验结果进行了比较.在43名通过Bonney测试证实压力性尿失禁的受试者中,我们记录了13例适当的轮廓测量结果。
    According to the International Continence Society, stress (static) urinary incontinence is defined as any involuntary loss of urine on effort or physical exertion, due to which intravesical pressure overcomes urethral pressure, with no detrusor activity. Urodynamic testing accurately assesses the function of the bladder and urethra. The urodynamic assessment includes three tests: cystometry, uroflowmetry and profilometry (determination of urethral pressure profile). Prior to urodynamic assessment, it is mandatory to rule out urinary tract infection since it is an invasive test. Urethral profilometry is a technique that measures pressure in the urethra and bladder at rest, during stressful actions, and during the act of miction. Its main purpose is to evaluate the sphincter mechanism. During the examination, a special catheter is used, which is being slowly pulled out from the bladder neck throughout the urethra, with continuous recording of intraurethral pressure. In addition to measuring urethral pressures, stress urinary incontinence is also very successfully proven by the cough test and Bonney test. If, on forced cough, the urine escapes uncontrollably, and continence is restored by finger lifting the neck of the bladder, the diagnosis of static incontinence is confirmed. At our urogynecologic clinic, urodynamic examination is being routinely performed. In the present study, we included patients previously treated for urinary stress incontinence and compared their results of urodynamic assessment to the results of Bonney test. Of the 43 subjects in whom stress incontinence was proven with Bonney test, we recorded an appropriate profilometry result in 13 cases.
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  • 文章类型: Journal Article
    背景:膀胱功能障碍,尤其是尿潴留,作为宫颈癌患者根治性子宫切除术后的重要并发症,主要是因为神经损伤,严重影响其术后生活质量。康复的挑战包括盆底肌肉训练不足以及术后留置导尿管的负面影响。间歇性导尿是神经源性膀胱管理的黄金标准,促进膀胱训练,这是一种重要的行为疗法,旨在通过训练尿道外括约肌增强膀胱功能,促进排尿反射的恢复。然而,目前关于间歇性导尿的最佳时机和膀胱功能障碍主观症状评估的研究仍存在空白.
    方法:本随机对照试验将招募接受腹腔镜根治性子宫切除术的宫颈癌患者。参与者将被随机分配到术后早期导管拔除联合间歇性导管插入组或接受标准护理并留置导尿管的对照组。所有这些患者将在手术后随访3个月。该研究的主要终点是术后2周膀胱功能恢复率的比较(定义为达到膀胱功能恢复II级或更高)。次要终点包括尿路感染的发生率,和尿动力学参数的变化,术后1个月内的MesureDuHandicapUrinaire评分。所有分析都将坚持意向治疗原则。
    结论:本试验的结果有望改善宫颈癌根治术患者的临床管理策略,以提高术后恢复。通过提供有力的证据,这项研究旨在支持患者及其家属在术后膀胱管理方面的知情决策,有可能降低泌尿系并发症的发生率,提高术后整体生活质量。
    背景:ChiCTR2200064041,9月24日注册,2022年。
    BACKGROUND: Bladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life. The challenges to recovery include insufficient pelvic floor muscle training and the negative effects of prolonged postoperative indwelling urinary catheters. Intermittent catheterization represents the gold standard for neurogenic bladder management, facilitating bladder training, which is an important behavioral therapy aiming to enhance bladder function through the training of the external urethral sphincter and promoting the recovery of the micturition reflex. Nevertheless, gaps remain in current research regarding optimal timing for intermittent catheterization and the evaluation of subjective symptoms of bladder dysfunction.
    METHODS: Cervical cancer patients undergoing laparoscopic radical hysterectomy will be recruited to this randomized controlled trial. Participants will be randomly assigned to either early postoperative catheter removal combined with intermittent catheterization group or a control group receiving standard care with indwelling urinary catheters. All these patients will be followed for 3 months after surgery. The study\'s primary endpoint is the comparison of bladder function recovery rates (defined as achieving a Bladder Function Recovery Grade of II or higher) 2 weeks post-surgery. Secondary endpoints include the incidence of urinary tract infections, and changes in urodynamic parameters, and Mesure Du Handicap Urinaire scores within 1 month postoperatively. All analysis will adhere to the intention-to-treat principle.
    CONCLUSIONS: The findings from this trial are expected to refine clinical management strategies for enhancing postoperative recovery among cervical cancer patients undergoing radical hysterectomy. By providing robust evidence, this study aims to support patients and their families in informed decision-making regarding postoperative bladder management, potentially reducing the incidence of urinary complications and improving overall quality of life post-surgery.
    BACKGROUND: ChiCTR2200064041, registered on 24th September, 2022.
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  • 文章类型: Journal Article
    这项研究探讨了慢性脊髓损伤(SCI)患者的15年泌尿系统并发症,并调查了视频尿动力学研究(VUDS)和膀胱管理的预测因素。分析864例SCI患者,平均随访15.6年,我们评估了并发症,并利用多变量逻辑回归进行风险评估.VUDS因素,如自主神经反射异常,逼尿肌括约肌协同失调,膀胱尿道反流(VUR),膀胱收缩,高排尿逼尿肌压力显着增加了复发性尿路感染(rUTI)的可能性。低膀胱顺应性,VUR,膀胱收缩显著增加了肾积水的风险,膀胱收缩和逼尿肌过度活动和逼尿肌活动不足会增加慢性肾脏疾病的风险。自愿排尿降低了rUTI和VUR风险,而Valsalva机动辅助排尿增加肾积水风险。总之,VUDS中发现的膀胱收缩与SCI的长期泌尿系统并发症相关,我们建议已经经历膀胱收缩的患者应优先考虑自愿排尿作为首选的膀胱管理策略,以最大限度地减少rUTI和VUR等其他并发症的风险.这些发现揭示了以前研究中未探索的方面,强调在这一患者人群中需要积极的管理策略。
    This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.
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  • 文章类型: Journal Article
    下尿路功能障碍在临床上很重要,因为它可能导致尿路感染,主要是由于残余尿液的积累,并对肾功能产生不利影响。此外,它可能会导致尿失禁,严重影响孩子的生活质量。下尿路的功能与肠功能密切相关,因为便秘通常伴随膀胱功能障碍。下尿路和肠道功能之间的相互作用,再加上常见的情况,如逼尿肌过度活动和排尿功能障碍,需要细致入微的诊断方法。逼尿肌过度活动,一种良性但对社会有害的疾病,是儿童日间尿失禁的主要原因。需要将其与更严重的疾病区分开来,例如神经源性膀胱功能障碍或尿道阻塞。排尿功能障碍,在排尿时习惯性的括约肌收缩,在逼尿肌过度活动的儿童中很常见,可能是自限性的,但也可能导致残余尿液和尿路感染。它可能类似于,在严重的情况下,神经源性膀胱功能障碍,最常见的原因是脊柱发育不良,这通常会导致尿路感染复发和膀胱内压高,危及肾功能.排尿日记对于儿童下尿路功能的初步评估至关重要。
    Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, it may cause urinary incontinence, strongly affecting the child\'s quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity and may be self limiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, neurogenic bladder dysfunction, most often caused by spinal dysraphism, which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. A voiding diary is crucial in the initial evaluation of lower urinary tract function in children.
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  • 文章类型: Journal Article
    准确测量后空隙残留(PVR)体积需要准确确定排尿时间,这在非语言患者中具有挑战性。作为原则的证明,我们试图测试可行性,使用遗尿症警报指示十名婴儿排尿的安全性和有效性。每个婴儿观察4小时,在尿布中报警,并且每15-30分钟检查一次尿布以确认排尿。在33个空隙中的31个(93.9%)激活了警报。无不良事件发生。进一步的工作将研究这种方法是否可以提高PVR测量的准确性。
    Accurate measurement of post-void residual (PVR) volumes requires accurate determination of the timing of voiding, which is challenging in non-verbal patients. As a proof of principle, we sought to test the feasibility, safety and efficacy of using an enuresis alarm to indicate voiding in ten infants. Each infant was observed for 4 h with alarm in the diaper, and diapers checked every 15-30 min to confirm voiding. The alarm activated in 31 of 33 voids (93.9%). No adverse events occurred. Further work will investigate whether this approach may improve accuracy of PVR measurement.
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