关键词: 脊髓发育不良, 尿路功能障碍, 神经源性膀胱, 尿动力, 膀胱扩大术

Abstract:

Objective To investigate risk factors for upper urinary tract damage in patients with myelodysplasia and to assess the efficacy of bladder augmentation for such patients. Methods A total of 150 patients were divided into two groups according to the standards of upper urinary tract damage for studying the relationship between upper urinary tract damage and age, gender, course of disease, previous spinal surgery, bladder management, and video urodynamic parameters. Then, 37 cases with bladder augmentation were screened to assess the efficacy of bladder augmentation by comparing renal function(serum creatinine value), hydronephrosis, ureteral dilatation, vesicoureteral reflux, bladder capacity, bladder compliance, maximum detrusor pressure before and after surgery. Results The poor bladder compliance(79.3%) was the most common finding in myelodysplasia patients with lower urinary tract dysfunction, and was a major risk factor for upper urinary tract damage(P=0.001, OR=2.802, 95%CI: 1.510-5.199). Bladder augmentation could not only improve bladder compliance(P=0.000), but also increase bladder capacity(P=0.000), reduce maximum detrusor pressure during urine storage period(P=0.008), thus improving renal function(P=0.000), hydronephrosis(94.2%), ureteral dilatation(94.0%) and vesicoureteral reflux(94.1%). Conclusion The poor bladder compliance was the most common finding in myelodysplasia patients with lower urinary tract dysfunction, and was a major risk factor for upper urinary tract damage. Bladder augmentation could stop and improve or even reverse the upper urinary tract damage.

Key words: myelodysplasia, urinary tract dysfunction, neurogenic bladder, urodynamic, bladder augmentation