| Background and objective: Neurogenic bladder-sphicter dysfunction (NBSD) is common in clinical practice, which is caused by neuropathic damage, such as spinal cord ageneisis. Pediatric NBSD is the most common urological disease in pediatric surgery. The deterioration of urinary tract is a major cause of morbidity and mortality for patients with NBSD. Upper tract deterioration was reported to occur in 40% to 90% of untreated by age 10 years and the whole mortality was 50% before 1970. In nowadays upper tract deterioration is reported to decreased to 30% to 40% and the mortality to 14% by age 5 years .Although different diagnostic methods in this field including B-mode ultrasound, intravenous urogram(IVU), renogram, computerized tomography(CT), magnetic resonance image(MRI), each of them exists limitation and can not figure out the spectrum and grades of disfunction of the bladder-sphicteric complex in the children with NBSD and upper urinary tract dilation It has been reported that manifestations and routine urological and neurologic examination can not evaluate the bladder-sphincter dysfunction accurately.Advances in urodynamic techniques specially designed for infants and young children have allowed more accurate assessment of bladder-sphincter disfuntion in the children with the NBSD, and urodynamic examination is the preferred examination for them. There are many studies about the relations between the urodynamic parameters of the bladder-sphicter and the upper urinary tract dilation in the children with the NBSD, but there are not studies about the relations between urodynamic parameters and the grades of the upper urinary tract dilation , between the relative unsafe cystometric capacity and the grades of upper urinary tract dilation, and the reciprocity of urodynamic risk factors. Therefore, it is crucial to investigate the value of these parameters in predicating and evaluating the prognosis of the upper urinary tract dilation related with the NBSD.The main objective of this thesis is to assess the value of urodyanmic study in predicating and evaluation of the upper urinary tract dilation caused by the NBSD by comparing the difference of urodynamic parameters between the children with different grades of upper urinary tract dilation and the ones without upper urinary tract dilation.Materials and methods:1. Patients: Fifty-four children with NBSD and upper urinary tract dilation and fifty-one with NBSD without upper urinary tract dilation were included in this study.(l)The patient group with upper urinary tract dilation: Fifty cases with bilateral hydronephrosis and four cases with unilateral hydronephrosis were included and they are proved by ultrasound and (or) intravenous urogram (IVU), and the patients with upper urinary tract dilation due to ureteric calculi and ureteropelvic junction obstrution were excluded. The mean age of the group with upper urinary tractdilation was 12 5y (male 40, female 14, range from ly to 18y).Grade of hydronephrosis: Children with upper urinary tract dilation were divided into three groups according to Society for Fetal Urology guidelines for grading hydronephrosis: Group 1,19 with grade 1 hydronephrosis with dilatation of pevis less than 1 cm; Group II , 18 with grade 2-3 hydronephrosis with dilatation of pevis more than 1cm but less than 1.5 cm; Group III, 17 with grade 4 ~5 hydronephrosis with dilatation of pevis more than 1.5cm.(2)The control group wtihout upper urinary tract dilation was proved by ultrasound and (or)intravenous urogram(IVU), whose mean age is 10 5y(male 34, female 17 ,range from 3m~18y) .2 Methods:(1)Urodynamic study: In this research free uroflowmetry, filling cystometry , pressure-flow- electromyography, urethral pressure measurement were performed in all patients according to the recommendations of the International Children Continence Society (ICCS). Urodynamic parameters inducing max free flow rate(MFR), post void residual(PVR) , maximum cystometric capacity(MCC) > neurogenic detrusor overactivity (NDOA) , detrusor-sphinc... |
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