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Objective To investigate the video-urodynamics indication of upper urinary tract dilation secondary to neurogenic bladder that may be resolved only by intermittent catheterization. Methods From January, 2008 to August, 2016, twelve cases of upper urinary dila-tion secondary to neurogenic bladder were treated by intermittent catheterization only. Their clinical data was reviewed. Results The mor-phology and function index of upper urinary tract were improved gradually during the regular follow-ups. The common video-urodynamics characteristics include no detrusor overactivity, no vesicoureteral reflux, cysctometry volume larger than 300 ml and detrusor presser at the capacity lower than 40 cmH2O, poor voiding efficiency with residual volume larger than 150 ml. Conclusion For upper urinary tract dilation secondary to neurogenic bladder characterized as passable storage and poor voiding, intermittent catheterization may be enough to resolve the dilation.
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Objective In children with neurogenic bladder and secondary vesicoureteral reflux , we ex-plore the differences of urodynamics between the children with and without detrusor overactivity (DO). The study is in order to provide theoretical support for clinical practice. Method From January 2013 to March 2016, 110 children with NB vesicoureteral reflux diagnosed by videourodynamics were recruited. There are 63 boys and 47 girls aged 4-12 years with mean of 7.5 years. According to presence of DO during the filling phase, the patients were divided into DO (n=32) and non-DO groups (n=78). The time of bladder ureter reflux perfusion and detru-sor pressure were recorded for calculation of bladder compliance when the reflux occurs in the two groups. Maximum cystometry capacity and maximum detrusor pressure were recorded for calculation of the bladder compliance at the end of filling in the two groups. According to the reflux flow level, patients were divided into mild reflux (Ⅰ-Ⅱdegrees), severe reflux (Ⅲ-Ⅴdegrees). The difference of reflux side of the two groups and reflux degree were an-alyzed. Result In DO group, bladder capacity and compliance were (107.5 ± 21.3) mL and (5.6 ± 1.8) mL/cmH2O, respectively, when bladder ureter reflux occurs. In non-DO group, the bladder ureter reflux bladder capac-ity and compliance were (124.7 ± 35.6) mL, (6.7 ± 2.3) mL/cmH2O. The two parameters were significantly differ-ent in both groups. In DO and non-DO groups, the detrusor pressure were (21.7 ± 8.3) cmH2O and (19.6 ± 9.2) cmH2O, respectively, which does not have any significant statistical difference. At the end of filling, bladder capac-ity and compliance in DO group were (198.7 ± 36.5) mL, (5.8 ± 1.9) mL/cmH2O. In non-DO group, bladder ca-pacity and compliance were (223.8 ± 40.2) mL and (6.5 ± 1.4)mL/cmH2O. In both group, there are difference. In DO group, there are 20 cases of unilateral reflux (63%) and 12 cases of bilateral reflux (37%). In non-DO group, there are 31 cases of unilateral reflux (40%) and 47 cases of bilateral reflux (60%). The reflux of the two groups are also serious. Conclusion Small bladder capacity and poor bladder compliance are the urodynamic characteris-tics of children with NB and secondary vesicoureteral reflux when DO occurs.
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Objective To explore the diagnosis and treatment of female bladder outlet obstruction (BOO) with bladder pain as major symptom.Methods From November 2008 to December 2012,21 female patients suffered from urinary frequency,urgency,pain in suprapubic area during bladder filling phase were enrolled in the study.Video-urodynamics (VUD) study combined with free urinary flow rate andresidual urine were performed in all patients in order to make the diagnosis of BOO clearly.The mean maximum urinary flow rate was (11.5±3.6) ml/s,and the mean maximal detrusor pressure was (39.1±17.8) cmH2O.Combining with the voiding radiography,19 patients were diagnosed as bladder neck obstruction,and the other 2 were diagnosed as urethral stricture.All patients were accepted the hydrodistension under the epidural anesthesia.The bladder biopsy was performed if the typical glomerulations were observed under the cystoscopy.Bladder neck incision and urethral dilatation were performed on these patients respectively.Symptom changes of bladder pain were recorded by using O'Leary-Sant scale,the pain,urgency,frequency symptom (PUF) scale and quality of Life (QOL) Scale.The data were collected within 48 months postoperation,respectively.Results The pathological findings of bladder mucosa biopsy showed acute or chronic inflammation in all patients.The mean follow-up was 6.7±5.9 months.We compared the corresponding data such as:voiding times per day,nocturnal frequency,O'Leary Sant scores,PUF and QOL between pre and post-treatment.Significant differences were observed during all corresponding data (P＜0.05).The voiding times per day changed from 24.3± 11.8 to 13.0±5.9.The nocturnal frequency decreased from 6.5±2.7 to 3.3± 1.6.O'Leary Sant scores changed from 24.6±7.3 to 14.7±7.4.The PUF scores changed from 22.9±6.2 to 12.0± 7.1.And the QOL scores changed from 5.0±0.8 to 2.9±1.5.Conclusions Free urinary flow rate and residual urine combined with VUD are very important in diagnosing female BOO with bladder pain as major symptom.Bladder pain symptoms will be significantly improved after the obstruction was relieved according to VUD results.
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@# Objective To discuss the video-urodynamic characteristics and management in infra-sacral cord injured patients. Methods The video-urodynamic finding and managements in 169 patients was reviewed. They were followed up for 2 years. Results Detrusor areflexia was found in 76.33% (129/169) patients, among them there were 27.22% (46/169) patients appeared hyper-compliance, and 7.10% (12/169) patients appeared reflux. The video-urodynamic characteristics showed over activity and low-compliance in 12.43% (21/169) patients, including reflux in 5 cases. Different management was chosen according to the video-urodynamic examination. No special complication was observed after 2 years follow-up. Conclusion The majority patients with infra-sacral cord injury appeared detrusor areflexia and hyper-compliance. Special management according to the video-urodynamic characteristics is important for protecting upper urinary tract and preventing urinary system infection.
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@#ObjectiveTo recognize the features of genitourinary dysfunction in multiple system atrophy (MSA) and the importance of videourodynamics.Methods5 cases of MSA were reviewed.ResultsGenitourinary dysfunction in MSA included voiding problem, nocturnal urinary frequency, urgency, impotence and so on. The characteristic appearance of videourodynamics was that postvoiding volume more than 100 ml, detrusor-external sphincter dyssynergia (DESD) and open bladder neck at the start of bladder filling. The abnormal sphincter electromyography comprised of abnormal spontaneous activity, motor unit potentials (MUPs) more than 13 ms, polyphasic potentials more than 60%. MRI showed brain atrophy and the "hot cross bun" signal in the pontocerebellar degeneration.ConclusionMSA is a disorder characterized by progressive neuronal atrophy at certain sites of the central nervous system that control the urogenital function. MSA-related urological symptoms are analogous with symptoms of bladder outlet obstruction. It is necessary to take some reasonable investigations for avoiding misdiagnosis and unnecessary surgery.
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@#ObjectiveTo explore the video-urodynamic characteristics of neurogenic bladder caused by suprapontine neuropathy.Methods65 patients with neurogenic bladder caused by suprapontine neuropathy were involved from February 2004 to May 2009. The data were analyzed retrospectively, including clinical manifestation, diagnosis, voiding management, ultrasound, uroflow, post void residual, filling cystometry, pressure-flow study and the radiology. The results were compared with those of the suprasacral spinal cord injury.ResultsNo significant difference was found in the urodynamic parameters between various kinds of suprapontine neuropathy. Compared with suprasacral spinal cord injury, suprapontine neuropathy had less detrusor-sphincter dyssynergia, less reflux and upper urinary tract dilation but more normal micturiton reflex.ConclusionThe main video-urodynamic characteristic of neurogenic bladder caused by suprapontine neuropathy is detrusor overactivity, and the detrusor-sphincter dyssynergia, reflux and upper urinary tract dilation are rare.
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@#Objective To explore the videourodynamic manifestation of neurogenic bladder after operation for lumbar intervertebral disk hernia. Methods A consecutive series of 25 patients with neurogenic bladder dysfunction after operation for lumbar intervertebral disk hernia were analysed retrospectively. They were respectively divided into L4-5 and L5-S1 groups according to the focus, or normal, injured and no-drawn groups according to saddle sensation. Their videourodynamic manifestation were analyzed statistically. Results Videourodynamic manifestation including bladder sensation,bladder compliance, stability, bladder neck's opening extent, bladder capacity and urethral pressures were not significantly different between the group L4-5 and L5-S1 (P>0.05), nor was the saddle sensation (P=0.51). But the bladder sensation and urethral pressures were related with the saddle sensation (P<0.05). Conclusion The videourodynamic changes may not be related with the focus, but the saddle sensation in patients after operation for lumbar intervertebral disk hernia, which need further elucidation.
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The objective of this paper was to describe the bladder and sphincter urodynamic profiles and the upper tract status of patients with myelomeningocoele. This was correlated with the patients age when initially evaluated. Patients from the Spina Bifida Support Group of the Philippines who underwent initial videourodynamics when first seen were included in the study. The procedure was performed using a Laborie Avanti 4.1 model urodynamic machine. The hostile profile included bladder-sphincter dyssynergia, dyssynergic bladder neck/sphincter or leak point pressure greater than 35 cm H2O. The non-hostile picture included areflexic bladder and sphincter, open or areflexic sphincter or leak point pressure less than 35 cm H2O. The upper tracts were also assessed for the presence of hydronephrosis or vesicoureteral reflux There were 83 myelomeningocoele patients who underwent screening videourodynamics. Their ages ranged from 2 months to 19 years. Fifty one patients presented with hostile bladder sphincter profile while 32 patients presented with non-hostile features. Among the patients with hostile features, 37 manifested with hydronephrosis and/or vesicoureteral reflux. Three patients already presented with renal failure. Beyond 2 years old, 34 patients showed hostile bladder sphincter profile. Sixteen patients already presented with hydronephrosis and/or reflux after the age of 5 years. Renal failure was manifested by older children, all exhibited hostile bladder sphincter features and upper tract deterioration. These data showed a positive correlation of age, hostile profile and upper tract changes in patients with myelomengocoele