| Objective To study bladder pathophysiological mechanism during natural filling phase at nigh in patients with primary nocturnal enuresis (PNE) and clinical treatment to make out treatment strategy.Materials and Methods 32 boys and 18 girls diagnosised PNE according to standardization of ICCS (1998), age from 5 to 14, median age 7.4 years, consisted of experimental group. The symptoms lasted from 6 months to 8 years. 30 cases, 19 boys and 11 girls, age 5 to 15, median age 7.1 years, admitted into hospital due to cryptorchidism without any lower urethral tract symptoms associated with frequent micturition, urgency of urination, wetting night,difficulty to urination were served as control group. There were not statistically differences in the age and sex between two groups(P>0.05). Preliminary examination included urinalysis, ultrasonic of urinary system, x-ray of spina, uroflowmetry to rule out abnormal anatomical structure, Then 7 days frequency-voiding diary recorded. At the 8thday, Polysomnoguaphic monitoring had been used during whole procedure in order to confirm the patients were asleep. Evaluation indexes were as follows. The frist was to record detrusor pressure, abdominal pressure, intravesical pressure, urethral pressure and EMG study of pelvic floor reflexes, and calculated bladder compliance (BC) according to the value between beginning of infusion and before voiding. The second was to assess detrusor instability(DI) during natural filling phase. The third was to analysis of detrusor-sphincter coordination during natural filling and voiding phase. The fourth was to evaluate functional bladder capacity from frequency-voiding diary. After urodynamic test was finished, all PNE patients were divided into 3 pathophysiological subtypes managed the therapeutic strategy according to the nrodynamic result. At the same time, 63 cases diagnosised PNE without urodynamic assessment but treated by pharmacologic therapy directly were served as control, the therapeutic period were 3 months in both groups. All chridren were followed-up at 3.6.12 month after the course ending. Result: First, 4 cases in experimental group appeared BC decreasing but no one in control. Second, the incidence of DI in experimental groups and controls was 58% and 10%, respectively, moreover; there were significant differences (P<0.01). The incidence of DI in each age-subgroup was 62.5%, 59% and 50%, respectively, there were no significant differences (P>0.05), but DI decreasing with age increasing. It suggested that the DI was an important factor for PNE. Third, during filling period, of 50 patients 8 appeared a phenomenon that the urethral pressure decreased when DI appeared, which was called detrusor-sphincter discoordination according to literature, and no identical phenomenon present in control. It indicated urethral dysfunction might be a factor for some PNE. During voiding phase, 48 in experimental groups and 28 in control showed a condition that urethral pressure and EMG of pelvic ploor increased when detrusor contraction appearing, there were no significant differences between two groups (P>0.05). It suggested detrusor-sphinctor discoordination might not be the pathophysiological mechanism during voiding in PNE but a fault caused by catheter. Fourth, in all patients, the functional bladder capacity (FBC) of experimental group was smaller than expected for age. The FBC of two group was 90.00±22.76ml and 254.66±36.15ml respectively. FBC of PNE was lower than that of control significantly (P<0.01), FBC/CBCnorm of experimental group located 40~60% mainly, and 80~100% in control as well (P<0.01). The FBC decreasing degree of PNE was higher than that of control but relieved with age increasing (P<0.05). Fifth, 50 cases were divided into three pathophysiological subtypes according to the urodynamic result, DI, FBC, detrusor-spinctor discoordination, respectively.Sixth, The cure rate of each subgroup for PNE was 84%, 82%, 70%, and that of control was 68%, 50%, 33%, respectively, The cure rate of ex... |
PDF Full Text Request