神经源性膀胱尿道功能障碍患者的影像尿动力学研究

目的 探讨各类神经源性膀胱患者的影像尿动力学特点.方法 2002年12月至2008年6月间,我们对1800例神经源性膀胱患者进行了影像尿动力学检查,分析不同神经病变所致膀胱尿道功能障碍的影像学特点.结果 脑卒中患者均未发现上尿路改变和反流,71% 为逼尿肌过度活动(DO),60% 伴括约肌无抑制性松弛,29% 为逼尿肌无反射(DA).脑外伤患者中70% 为DO不伴协同失调.7例帕金森病患者均表现为DO.1170例骶上损伤患者91% 为DO,83% 伴逼尿肌括约肌协同失调(DSD),223例骶髓及以下损伤患者73% 为DA.共有12% 的创伤性脊髓损伤患者出现上尿路积水改变,4% 表现为膀胱输尿管反流.脊髓发育不良患者81% 表现为逼尿肌无反射,86% 膀胱顺应性下降,55% 有上尿路积水改变,31% 出现膀胱输尿管反流.腰椎间盘突出患者92% 为逼尿肌无反射,88% 膀胱顺应性基本正常.糖尿病膀胱患者81% 膀胱感觉减退,76% 排尿期逼尿肌收缩力低下.结论 不同神经病变所致神经源性膀胱尿道功能障碍的特点不同,应根据影像尿动力学检查结果 选择合适的临床治疗方案.

Video-urodynamic studies on 1800 patients with neurogenic bladder

Objective To explore the Video-uredynamic characteristics of various neurogenic bladder.Methods A total of 1800 patients with neurogenie bladder were included in our study from December 2002 to June 2008.All pailents underwent Video-uredynamie studies.Urodynamic data was collected and analyzed.Results Urodynamic study showed detrusor overactidty in 71% .of which 60% with uninhibited 8phincter relaxation,and aeontractile detrusor in 29% stroke patients.No upper urinary tract deterioration was found in all 42 stroke patients.Detrusor overactivitv without sphincter dyssynersia was found in 70% patients with head trauma.Seven patients with Parkinson disease showed detrusor overactivity.of which 3 with delayed sphincter relaxation.Detrusor overaetivity was found in 91% and detrusor sphincter dyssynergia in 83% suprasacral spinal cord injured patients.Acontractile detmsor was found in 73% patients with conu8 medullaris and cauda equina injury.Overall,upper urinary tract changes were found in 12% and vesicoureteral reflux in 4% spinal cord ijured patients.Urodynamic study showed acontractile detrusor in 81%.reduced compliance in 86%.upper urinary tract changes in 55% and vesicoureteral reflux in 33% patients with myelodysplasia.Most patients(92% )with protruded lumbar disc showed detruscr areflexia.Normal bladder compliance was found iU 88% patients with protruded lumbar disc.Uredynamic study showed reduced bladder sensation in 81% and detmsor underactivity in 76% patients with diabetic eystopathy.Conclusions Video-urodynamic study can provide the most detailed information about tlle bladder dysfuncfion.It is the most valuable examination before treatment of patients with neurogenic bladder.