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首页> 外文期刊>BJU international >Detrusor after-contractions in children with normal urinary tracts.
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Detrusor after-contractions in children with normal urinary tracts.

机译：尿路正常的儿童的逼尿肌收缩后。

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Objective To assess the clinical significance of after-contractions (A-Cs) in children with normal urinary tracts. Patients and methods Urodynamic records obtained in 315 children with urinary infection or enuresis were reviewed retrospectively; 184 were selected for analysis of A-Cs. All patients had normal urinary tracts and none showed signs of an overt neuropathy. The urodynamic method comprised standard measurements of pressures and flowmetry (42 had video-urodynamic studies). Results After-contractions occurred in 151 of the 184 patients; the incidence tended to decrease with age. The mean amplitude of the A-Cs was 77.9 cmH2O; in 36% of the records it was higher than the voiding contraction. Residual urine was found in 12 of 151 records with A-Cs, but in only one patient was such residual urine confirmed in control voids. The patterns were assessed in 131 patients: in 36% they resembled stop-test responses, in 31% they were preceded by brief peaks of pressure or had jagged limbs, and in 33% they were grossly irregular. In 137 records the content of the bladder was estimated at the start of A-Cs; in 51% the bladder was empty or had evacuated >95% of its content, in 39% 95-80% and in 10% <80%. In only 7% of the patients had the A-Cs started after the voiding contraction had completely subsided. There was no difference in the incidence of A-Cs in girls with enuresis (84%) and girls with a history of urinary infections (85%). Detrusor instability was detected in 81% of the children with A-Cs and in 70% of those without; there was no correlation between the amplitudes of uninhibited detrusor contractions and of A-Cs. Characteristic images of external sphincter activity were found in only three of 14 video-urodynamic recordings with A-Cs. Conclusions After-contractions are common in children with normal urinary tracts but they tend to disappear with age. In clinical urodynamics they are of limited practical use because their appearance is unpredictable and there are artefacts related to recording the final phase of micturition. The relationship with detrusor instability may be explained as a coincidence of two common but unrelated findings, and A-Cs are unrelated to urinary infection. External sphincter activity is not the only cause of A-Cs and when it occurs it does not alter the course of voiding, as it does in neuropathic dysfunctions. As their clinical significance is uncertain, treatment of A-Cs is not advocated.
机译：目的评估正常尿路患儿收缩后（A-Cs）的临床意义。回顾性分析了315例尿路感染或遗尿儿童的尿动力学记录。选择了184个进行A-C分析。所有患者泌尿道均正常，无明显神经病变迹象。尿流动力学方法包括压力和流量测量的标准测量（42次进行了视频尿流动力学研究）。结果184例患者中有151例发生收缩后。发病率随年龄增长而降低。 A-Cs的平均振幅为77.9 cmH2O;在36％的记录中，该值高于排尿收缩率。 151例A-C记录中有12例发现残留尿液，但只有一名患者在对照空洞中证实了这种残留尿液。在131例患者中评估了这种模式：在36％的患者中，他们表现出类似停止测试的反应;在31％的患者中，出现短暂的压力峰值或肢体呈锯齿状;在33％的患者中，患者的症状严重不规则。在137条记录中，在A-C开始时估计了膀胱的内容;在51％的人中，膀胱是空的或已排空了其含量的> 95％;在39％的患者中，其排空率为95-80％;在10％<80％的情况中，则是排空。排尿收缩完全消失后，只有7％的患者开始A-C。有遗尿的女孩（84％）和有泌尿感染史的女孩（85％）的A-Cs发生率没有差异。在81％有A-C的儿童和70％没有A-C的儿童中发现逼尿肌不稳定。不受抑制的逼尿肌收缩幅度与A-C幅度之间没有相关性。在具有A-C的14个视频尿动力学记录中，只有3个发现了外部括约肌活动的特征图像。结论尿路正常的小儿后收缩很常见，但随着年龄的增长往往会消失。在临床尿动力学中，它们的实际用途受到限制，因为它们的外观是不可预测的，并且存在与记录排尿最后阶段有关的伪像。与逼尿肌不稳定的关系可以解释为两个常见但不相关的发现的巧合，A-C与尿路感染无关。外部括约肌活性不是引起A-C的唯一原因，当它发生时，它不会改变排尿的过程，就像在神经性功能障碍中一样。由于其临床意义尚不确定，因此不主张治疗A-C。

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