| Nocturnal enuresis(nocturnal enuresis,NE)is a common disease in children,and has significantly impact and mental illness for children and family life.At present,it is not clear about the lower bladder function,abnormal urination,and the interaction between bladder and central dysfunction in children with NE.This study attempts to have resting state functional MRI of the brain and ambulatory urodynamics monitoring(AUM)test during sleep at night in NE children,as well as evaluate the control store urine voiding function and dysfunction of brain microstructure area,to know exactly what children with bladder dysfunction of urinary dysfunction central at night and the correlation between them,to understand the pathogenesis of NE,and carry out effective individualized treatment provides definite theoretical basis.Part One Study on resting functional magnetic resonance of abnormal functional connections in children with primary monosymptomatic enuresisObjective The Rs-fMRI(resting-state functional magnetic resonance imaging,Rs-fMRI)results of children with PMNE(primary nocturnal enuresis,PMNE)and those in the control group were compared to find out whether there were abnormal brain functional connectivity,so as to provide objective basis for Individualized accurate diagnosis and treatment.Methods All resting state scan was performed on the 3.0T fMRI system.Patient groups:51 children with PMNE(28 males and 23 females);Control group:45 children(24 males and 21 females)with normal lower urinary tract function.Bilateral thalamus and bilateral anterior cingulate gyrus were used as seed points for seed-based functional connectivity(seed-based functional connectivity,seed-based FC)analysis.Pearson correlation analysis were performed between abnormal functional connections,age and enuresis severity in PMNE children.ResultsThe average age of PMNE and the control group were(11.2±2.3,11.9±2.6)years old,and the ratio of male to female was 28/23,24/21,respectively.Gender and age were not statistically significant between the PMNE and the control group(P>0.05).In addition,there was no statistical difference between the two groups in terms of body weight,maximum voiding volume(MVV)and nocturnal urine volume(NUV)(P>0.05).1.The severity of enuresis in PMNE group(enuresis frequency)was 3.8±1.5 times per week.Compared to the control group,the functional connection between the left thalamus(MNI coordinate:-11,-18,8)and the left medial superior frontal gyrus(Frontal_Sup_Medial_L,AAL)in the PMNE group was significantly decreased.2.The right thalamus(MNI coordinate:13,-18,8),the left anterior cingulate gyrus(MNI coordinate:-4,35,14),and the right anterior cingulate gyrus(MNI coordinate:8,37,16)were used as seed points,there was no significant difference in functional connections between the two groups.3.Functional connection of left thalamus and left medial superior frontal gyrus(Frontal_Sup_Medial L,AAL)in children with PMNE was negatively correlated with enuresis severity(enuresis frequency:/week)(r=-0.369,P=0.008).ConclusionIn children with PMNE,there is an abnormal resting functional connection pattern between the left thalamus and the left medial superior frontal gyrus,which is related to the severity of enuresis.These findings elucidated the possible neuropathologic pathogenesis in children with PMNE,which will contribute to a better understanding of the pathophysiological pathogenesis,and provide a reliable imaging basis for children with PMNE to clarify the etiology of the disease,guide treatment and evaluate treatment prognosis.Part Two Evaluation of refractory monosymptomatic nocturnal enuresis with ambulatory urodynamics monitoring and conventional urodynamics:a comparative studyObjective The urodynamic parameters of children with refractory monosymptomatic nocturnal enuresis(RMNE)were evaluated by comparing ambulatory urodynamics monitoring(AUM)with conventional urodynamics(CUD).To explore the clinical value of AUM in the diagnosis and treatment of children with RMNE.Methods A total of 40 children(22 males and 18 females)diagnosed with RMNE were collected,aged 9-16 years,and the frequency of nocturnal bed-wetting≥2 times/week.CUD and 1 sleep cycle AUM were performed,and urodynamic parameters were recorded and statistically analyzed.ResultsFive of the 40 children dropped out of the study because of the poor compliance.The average age of children in the RMNE group was(12.6±2.1)years old,the ratio of male to female was 19/16,and the severity of enuresis symptoms(enuresis frequency)was 4.2±1.7 times per week.Comparison of urodynamic parameters between AUM group and CUD group:1.There were significant differences in Bladder compliance(BC)and Maximum detrusor pressure(Pmax.det)(BC:28.4±7.7 ml/cmH20 vs.23.6±6.1 ml/cmH20.Pmax.det:44.6±9.1 cmH20 vs.23.6±6.1 cmH20;P<0.05).2.There was no significant difference in maximum flow rate(Qmax)and post void residual(PVR)between the AUM group and the CUD group(Qmax:19.6±7.2 ml/s vs.20.9±5.4 ml/s.PVR:9.5±5.7ml vs.10.9±5.3ml;P>0.05).3.Detrusor overactivity(DO)was detected in 27 cases(77.1%)in the examination of AUM and in 16 cases(45.7%)in the examination of CUD(P<0.05).Among them,15(45.7%)children with DO were founded both in CUD and AUM examination.12 children(34.3%),there was no DO in CUD,but in AUM.For the 15 children with DO detected by both CUD and AUM:The DO frequency was 3.1±1.0 times/h,and the maximum value of DO was 22.9±4.5 cmH20.In the CUD test,the frequency of DO was 2.4±0.8 times/h,and the maximum value of DO was 19.2±4.0 cmH2O.As for two indicators,the AUM group was significantly higher than the CUD group(P<0.05).4.In addition,the normal desire cystometric capacity(NDCC)of 35 children with RMNE was 235.8±84.7ml.MCC was 322.6±70.8 ml.ConclusionAUM examination can diagnose whether children with RMNE are accompanied by bladder dysfunction,and it is more accurate than CUD in evaluating BC,Pmax.Det,DO,etc.Especially for RMNE children with unsatisfactory CUD results,further AUM examination is recommended to clarify the etiology. |
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