The Videourodynamic Study In Neurogenic Bladder-sphineter Dysfunction With Upper Urinary Tract Dilation

ObjectiveThe aim of this study was to investigate the urodynamic feature of neurogenic bladder-sphineter dysfunction (NBSD) with upper urinary tract dilatation (UUTD) and those with no NBSD, providing evidence for clinical diagnosis, treatment and prognosis.MethodsA total of50patients with NBSD at The First Affiliated Hospital of Zhengzhou University from April to November2011were included in this study. Video-urodynamics study were carried on these patients. Among them,25patients (12males,13females,(29±17) years on average) companied with UUTD which were confirmed by B ultrasound or urography. Ureteral calculi and stenosis were excluded. Meanwhile,25NBSD patients without upper urinary tract dilation (13males,12females, averaged (27±16) years old) were taken as control group.MMS urodynamic equipment(Holand), Philips Mobile C-arm X-ray machine (type:BV Endura, Holand) were used in this study. The male patients took standing position, females and children took seat. The media of100ml diatrizoate (concentration76%) was injected into400ml normal saline were used for filling cystometry (The concentration of diatrizoate become15%). Infusion rate was10-20ml/min. Ten F (adults) or6F (children) double-lumen cystometry tube was indwelled transurethrally. Disposable manometry catheter was indwelled in the rectum and properly fixed. Urodynamic parameters such as vesica pressure (Pves), abdom pressure (Pabd), detrusor pressure (Pdet), maximal cystometric capacity (MCC), bladder compliance (BC), detrusor contractility, post-voiding residual (PVR) was recorded.ResultsAbnormal bladder morphology was found in80%of the patients with UUTD, which was higher than that of control group (29%). Among them,20cases accompanied with coarse bladder wall,14cases with trabecula and diverticulum,9cases with a "Christmas tree-like" or "pagoda-like" bladder. In the control group, abnormal bladder modality was found in7cases (28%), trabecula and diverticulum was found in3cases (12%). The bladder compliance of patients with UUTD was significant lower than that of the control group (P<0.05). DLPP and PVR was higher than the control group (P<0.05). The maximal cystometric capacity between the two group has no difference between the two groups (P>0.05).Vesicoureteral reflux (VUR) occurred in7cases of NBSD with UUTD. Among them,5cases were reflux in low bladder pressure. The incidence of detrusor acontractile in NBSD with UUTD was85%, much higher than that of the control group (29%). DLPP>40cmH2O in45%of the patients with NBSD and UUTD, but only14%of the cases occurred in the control group. Abnormal bladder neck open occured in75%of patients with NBSD and UUTD, much higher than that of the control group (33%)(P<0.05)ConclusionAbnormal bladder morphology、ACD、high DLPP and the increase of PVR were important factors to predicting UUTD caused by NBSD. It is helpful to have an X-ray video-urodynamic study for patients with NBSD for evaluation of bladder function and morphology as well as upper urinary tract.