小儿神经源性膀胱合并上尿路扩张尿动力学机制探讨
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摘要
背景和目的
研究背景
任何神经病变或损害引起膀胱和括约肌功能障碍称之为神经源性膀胱括约肌功能障碍(neurogenic bladder-sphicter dysfunction，NBSD)。小儿神经源性膀胱发病率很高，多为脊髓发育不良引起。脊髓脊膜膨出发病率为1‰～2‰，在十九世纪七十年代以前未治疗NBSD患儿10岁前上尿路损害发生率可达50％～90％，总死亡率可达50％；目前仍有30～40％出现肾功能损害，5岁前死亡率高达14％。主要死亡原因为膀胱括约肌功能障碍导致的上尿路损害，最终肾功能衰竭。现代超声、静脉尿路造影、核素肾扫描、CT、MRI及磁共振尿路成像(magnetic resonance urography，MRU)等检查均可不同程度了解NBSD患者上尿路损害的程度。超声可以无创伤了解上尿路扩张的形态以及部分地反映肾脏的功能(如肾脏血流阻力指数比率可以反映尿路梗阻引起的肾脏血流循环阻力升高，用于评估肾积水肾脏的功能)。肾核素扫描是公认的能够较为准确反映分肾功能以及肾脏引流状况的影像检查手段，但其易受到肾脏功能的影响并有较高的假阳性率以及假阴性率，检查过程也较为复杂、要接受一定量的辐射。静脉尿路造影也能部分的反映分肾功能，形象的显示肾盂扩张的形态，但也受肾功能、积水量以及胃肠道气体的影响常常显影效果不佳甚至不能显影。Gd-DTPA增强磁共振肾扫描能够清晰的显示肾脏结构以及功能状况，可能是将
郑州大学2004届硕士研究生毕业论文(摘要部分).J”)L神经源性膀肤合并上尿路扩张的尿动力学机制探讨
来发展的方向，尚处于试验阶段，尚未推广。但针对小儿NBSD患者而言，引
起上尿路扩张损害的主要原因为神经源性下尿路功能障碍，上述检查仅能了解
上尿路损害的现状和程度，不能了解上尿路扩张损害的原因，即下尿路膀肤括
约肌功能障碍的类型和严重程度，不能为临床预防治疗上尿路扩张损害以及评
估其预后提供客观依据。
从神经系统和临床症状角度了解小儿NBSD患者膀肤括约肌功能障碍的类
型，国内外许多学者也进行了大量研究。Miche1A等1995年对151例高位脊
膜膨出新生患儿尿动力学研究发现，有一半以上患儿可保留能髓功能，表现为
存在尿道括约肌活动性和膀肌反射的能力;是否保留能髓功能与病变位置水平
高低无关。PalmerLS等1998年对20例无泌尿系症状被确诊为脊髓拴系患儿
进行外科松解治疗，术前全部患儿都存在尿动力学检查异常，术后75%患儿尿
动力学参数有所改善。WarderDE等研究发现部分病例圆锥位置正常却发生神
经损害症状，而SostrinRD等1997年发现有些病例脊髓圆锥低位，长期随访
并未出现神经损害症状。卫中庆等1998年对31例隐性脊柱裂患者进行尿动力
学评估发现隐性能椎裂部位、程度与排尿障碍、神经源性膀肤功能障碍类型无
对应关系;李金良等2002年对66例脊髓拴系患者尿动力学检查、MRI检查结
果进行分析，也发现脊髓圆锥位置与上尿路损害及尿动力学表现类型无相关关
系。上述研究提示仅依据临床症状，神经系统体检和神经系统影像学检查对小
儿NBSD评估，不能准确了解其膀耽括约肌功能障碍特点;同时NBSD患儿因神
经损害发生变化如进行性脊髓束缚以及继发于膀肤括约肌的自然发育，患儿膀
肤括约肌功能障碍类型也可发生改变。
目前认为小儿尿动力学检查，是评估小儿NBSD膀肤功能障碍类型、预测
上尿路损害和为临床治疗提供依据的首选检查。国内外学者也应用小儿尿动力
学检查对小儿NBSD患者膀肤括约肌的尿动力学参数与上尿路损害之间的联系
进行了大量的研究。但是，这些研究多仅为发生上尿路损害与无上尿路损害之
郑州大学2004届硕士研究生毕业论文(摘要部分)小)L神经源性膀肤合并上尿路扩张的尿动力学机制探讨
间进行尿动力学参数整体分析比较。对于排尿期逼尿肌无收缩与存在收缩进行
分类比较，研究二者上尿路损害危险因素的区别;对于相对危险膀肤容量进行
详细的尿动力学分析;对于尿动力学危险因素之间相互作用，以及上尿路损害
程度与下尿路尿动力学参数关系的研究等国内外未见报道。故神经源性膀肤括
约肌功能障碍患者发生上尿路损害的尿动力学机制仍有许多疑问，是临床迫待
解决的课题。进行本课题研究对临床更有效的指导NBSD治疗，防治上尿路损
害的发生有着重要意义。
研究目的
本研究拟通过回顾性分析2002年3月一2004年1月被确诊为神经源性膀
肤患儿的尿动力学检查结果，比较无上尿路扩张组和不同程度上尿路扩张组之
间，无上尿路扩张组和上尿路扩张组中存在逼尿肌收缩患儿之间的膀肤括约肌
尿动力学参数差异，分析相对危险容量和尿动力学危险因素之间相互作用与发
生上尿路扩张之间的联系，探讨神经源性膀肤患儿发生上尿路扩张的尿动力学
机制，为临床预防和治疗神经源性膀肤患儿发生上尿路扩张损害以及评估其预
后提供客观依据。
材料与方法:
病人组
选取神经源性膀肤括约肌功能障碍患者105例。其中上尿路扩张组54例(男
40例，女14例，1岁一18岁，平均年龄12士5岁)包括50例双侧肾积水(伴
双侧输尿管扩张45例，单侧输尿管扩张5例)和4例单侧肾积水(均伴有输尿
管扩张)。所有上尿路扩张患者均经超声或肾盂静脉?
Background and objective: Neurogenic bladder-sphicter dysfunction (NBSD) is common in clinical practice, which is caused by neuropathic damage, such as spinal cord ageneisis. Pediatric NBSD is the most common urological disease in pediatric surgery. The deterioration of urinary tract is a major cause of morbidity and mortality for patients with NBSD. Upper tract deterioration was reported to occur in 40% to 90% of untreated by age 10 years and the whole mortality was 50% before 1970. In nowadays upper tract deterioration is reported to decreased to 30% to 40% and the mortality to 14% by age 5 years .
Although different diagnostic methods in this field including B-mode ultrasound, intravenous urogram(IVU), renogram, computerized tomography(CT), magnetic resonance image(MRI), each of them exists limitation and can not figure out the spectrum and grades of disfunction of the bladder-sphicteric complex in the children with NBSD and upper urinary tract dilation It has been reported that manifestations and routine urological and neurologic examination can not evaluate the bladder-sphincter dysfunction accurately.
Advances in urodynamic techniques specially designed for infants and young children have allowed more accurate assessment of bladder-sphincter disfuntion in the children with the NBSD, and urodynamic examination is the preferred examination for them. There are many studies about the relations between the urodynamic parameters of the bladder-sphicter and the upper urinary tract dilation in the children with the NBSD, but there are not studies about the relations between urodynamic parameters and the grades of the upper urinary tract dilation , between the relative unsafe cystometric capacity and the grades of upper urinary tract dilation, and the reciprocity of urodynamic risk factors. Therefore, it is crucial to investigate the value of these parameters in predicating and evaluating the prognosis of the upper urinary tract dilation related with the NBSD.
The main objective of this thesis is to assess the value of urodyanmic study in predicating and evaluation of the upper urinary tract dilation caused by the NBSD by comparing the difference of urodynamic parameters between the children with different grades of upper urinary tract dilation and the ones without upper urinary tract dilation.
Materials and methods:
1. Patients: Fifty-four children with NBSD and upper urinary tract dilation and fifty-one with NBSD without upper urinary tract dilation were included in this study.
(l)The patient group with upper urinary tract dilation: Fifty cases with bilateral hydronephrosis and four cases with unilateral hydronephrosis were included and they are proved by ultrasound and (or) intravenous urogram (IVU), and the patients with upper urinary tract dilation due to ureteric calculi and ureteropelvic junction obstrution were excluded. The mean age of the group with upper urinary tract
dilation was 12 5y (male 40, female 14, range from ly to 18y).Grade of hydronephrosis: Children with upper urinary tract dilation were divided into three groups according to Society for Fetal Urology guidelines for grading hydronephrosis: Group 1,19 with grade 1 hydronephrosis with dilatation of pevis less than 1 cm; Group II , 18 with grade 2-3 hydronephrosis with dilatation of pevis more than 1cm but less than 1.5 cm; Group III, 17 with grade 4 ~5 hydronephrosis with dilatation of pevis more than 1.5cm.
(2)The control group wtihout upper urinary tract dilation was proved by ultrasound and (or)intravenous urogram(IVU), whose mean age is 10 5y(male 34, female 17 ,range from 3m~18y) .
2 Methods:
(1)Urodynamic study: In this research free uroflowmetry, filling cystometry , pressure-flow- electromyography, urethral pressure measurement were performed in all patients according to the recommendations of the International Children Continence Society (ICCS). Urodynamic parameters inducing max free flow rate(MFR), post void residual(PVR) , maximum cystometric capacity(MCC) > neurogenic detrusor overactivity (NDOA) , detrusor-sphinc
研究背景
任何神经病变或损害引起膀胱和括约肌功能障碍称之为神经源性膀胱括约肌功能障碍(neurogenic bladder-sphicter dysfunction，NBSD)。小儿神经源性膀胱发病率很高，多为脊髓发育不良引起。脊髓脊膜膨出发病率为1‰～2‰，在十九世纪七十年代以前未治疗NBSD患儿10岁前上尿路损害发生率可达50％～90％，总死亡率可达50％；目前仍有30～40％出现肾功能损害，5岁前死亡率高达14％。主要死亡原因为膀胱括约肌功能障碍导致的上尿路损害，最终肾功能衰竭。现代超声、静脉尿路造影、核素肾扫描、CT、MRI及磁共振尿路成像(magnetic resonance urography，MRU)等检查均可不同程度了解NBSD患者上尿路损害的程度。超声可以无创伤了解上尿路扩张的形态以及部分地反映肾脏的功能(如肾脏血流阻力指数比率可以反映尿路梗阻引起的肾脏血流循环阻力升高，用于评估肾积水肾脏的功能)。肾核素扫描是公认的能够较为准确反映分肾功能以及肾脏引流状况的影像检查手段，但其易受到肾脏功能的影响并有较高的假阳性率以及假阴性率，检查过程也较为复杂、要接受一定量的辐射。静脉尿路造影也能部分的反映分肾功能，形象的显示肾盂扩张的形态，但也受肾功能、积水量以及胃肠道气体的影响常常显影效果不佳甚至不能显影。Gd-DTPA增强磁共振肾扫描能够清晰的显示肾脏结构以及功能状况，可能是将
郑州大学2004届硕士研究生毕业论文(摘要部分).J”)L神经源性膀肤合并上尿路扩张的尿动力学机制探讨
来发展的方向，尚处于试验阶段，尚未推广。但针对小儿NBSD患者而言，引
起上尿路扩张损害的主要原因为神经源性下尿路功能障碍，上述检查仅能了解
上尿路损害的现状和程度，不能了解上尿路扩张损害的原因，即下尿路膀肤括
约肌功能障碍的类型和严重程度，不能为临床预防治疗上尿路扩张损害以及评
估其预后提供客观依据。
从神经系统和临床症状角度了解小儿NBSD患者膀肤括约肌功能障碍的类
型，国内外许多学者也进行了大量研究。Miche1A等1995年对151例高位脊
膜膨出新生患儿尿动力学研究发现，有一半以上患儿可保留能髓功能，表现为
存在尿道括约肌活动性和膀肌反射的能力;是否保留能髓功能与病变位置水平
高低无关。PalmerLS等1998年对20例无泌尿系症状被确诊为脊髓拴系患儿
进行外科松解治疗，术前全部患儿都存在尿动力学检查异常，术后75%患儿尿
动力学参数有所改善。WarderDE等研究发现部分病例圆锥位置正常却发生神
经损害症状，而SostrinRD等1997年发现有些病例脊髓圆锥低位，长期随访
并未出现神经损害症状。卫中庆等1998年对31例隐性脊柱裂患者进行尿动力
学评估发现隐性能椎裂部位、程度与排尿障碍、神经源性膀肤功能障碍类型无
对应关系;李金良等2002年对66例脊髓拴系患者尿动力学检查、MRI检查结
果进行分析，也发现脊髓圆锥位置与上尿路损害及尿动力学表现类型无相关关
系。上述研究提示仅依据临床症状，神经系统体检和神经系统影像学检查对小
儿NBSD评估，不能准确了解其膀耽括约肌功能障碍特点;同时NBSD患儿因神
经损害发生变化如进行性脊髓束缚以及继发于膀肤括约肌的自然发育，患儿膀
肤括约肌功能障碍类型也可发生改变。
目前认为小儿尿动力学检查，是评估小儿NBSD膀肤功能障碍类型、预测
上尿路损害和为临床治疗提供依据的首选检查。国内外学者也应用小儿尿动力
学检查对小儿NBSD患者膀肤括约肌的尿动力学参数与上尿路损害之间的联系
进行了大量的研究。但是，这些研究多仅为发生上尿路损害与无上尿路损害之
郑州大学2004届硕士研究生毕业论文(摘要部分)小)L神经源性膀肤合并上尿路扩张的尿动力学机制探讨
间进行尿动力学参数整体分析比较。对于排尿期逼尿肌无收缩与存在收缩进行
分类比较，研究二者上尿路损害危险因素的区别;对于相对危险膀肤容量进行
详细的尿动力学分析;对于尿动力学危险因素之间相互作用，以及上尿路损害
程度与下尿路尿动力学参数关系的研究等国内外未见报道。故神经源性膀肤括
约肌功能障碍患者发生上尿路损害的尿动力学机制仍有许多疑问，是临床迫待
解决的课题。进行本课题研究对临床更有效的指导NBSD治疗，防治上尿路损
害的发生有着重要意义。
研究目的
本研究拟通过回顾性分析2002年3月一2004年1月被确诊为神经源性膀
肤患儿的尿动力学检查结果，比较无上尿路扩张组和不同程度上尿路扩张组之
间，无上尿路扩张组和上尿路扩张组中存在逼尿肌收缩患儿之间的膀肤括约肌
尿动力学参数差异，分析相对危险容量和尿动力学危险因素之间相互作用与发
生上尿路扩张之间的联系，探讨神经源性膀肤患儿发生上尿路扩张的尿动力学
机制，为临床预防和治疗神经源性膀肤患儿发生上尿路扩张损害以及评估其预
后提供客观依据。
材料与方法:
病人组
选取神经源性膀肤括约肌功能障碍患者105例。其中上尿路扩张组54例(男
40例，女14例，1岁一18岁，平均年龄12士5岁)包括50例双侧肾积水(伴
双侧输尿管扩张45例，单侧输尿管扩张5例)和4例单侧肾积水(均伴有输尿
管扩张)。所有上尿路扩张患者均经超声或肾盂静脉?
Background and objective: Neurogenic bladder-sphicter dysfunction (NBSD) is common in clinical practice, which is caused by neuropathic damage, such as spinal cord ageneisis. Pediatric NBSD is the most common urological disease in pediatric surgery. The deterioration of urinary tract is a major cause of morbidity and mortality for patients with NBSD. Upper tract deterioration was reported to occur in 40% to 90% of untreated by age 10 years and the whole mortality was 50% before 1970. In nowadays upper tract deterioration is reported to decreased to 30% to 40% and the mortality to 14% by age 5 years .
Although different diagnostic methods in this field including B-mode ultrasound, intravenous urogram(IVU), renogram, computerized tomography(CT), magnetic resonance image(MRI), each of them exists limitation and can not figure out the spectrum and grades of disfunction of the bladder-sphicteric complex in the children with NBSD and upper urinary tract dilation It has been reported that manifestations and routine urological and neurologic examination can not evaluate the bladder-sphincter dysfunction accurately.
Advances in urodynamic techniques specially designed for infants and young children have allowed more accurate assessment of bladder-sphincter disfuntion in the children with the NBSD, and urodynamic examination is the preferred examination for them. There are many studies about the relations between the urodynamic parameters of the bladder-sphicter and the upper urinary tract dilation in the children with the NBSD, but there are not studies about the relations between urodynamic parameters and the grades of the upper urinary tract dilation , between the relative unsafe cystometric capacity and the grades of upper urinary tract dilation, and the reciprocity of urodynamic risk factors. Therefore, it is crucial to investigate the value of these parameters in predicating and evaluating the prognosis of the upper urinary tract dilation related with the NBSD.
The main objective of this thesis is to assess the value of urodyanmic study in predicating and evaluation of the upper urinary tract dilation caused by the NBSD by comparing the difference of urodynamic parameters between the children with different grades of upper urinary tract dilation and the ones without upper urinary tract dilation.
Materials and methods:
1. Patients: Fifty-four children with NBSD and upper urinary tract dilation and fifty-one with NBSD without upper urinary tract dilation were included in this study.
(l)The patient group with upper urinary tract dilation: Fifty cases with bilateral hydronephrosis and four cases with unilateral hydronephrosis were included and they are proved by ultrasound and (or) intravenous urogram (IVU), and the patients with upper urinary tract dilation due to ureteric calculi and ureteropelvic junction obstrution were excluded. The mean age of the group with upper urinary tract
dilation was 12 5y (male 40, female 14, range from ly to 18y).Grade of hydronephrosis: Children with upper urinary tract dilation were divided into three groups according to Society for Fetal Urology guidelines for grading hydronephrosis: Group 1,19 with grade 1 hydronephrosis with dilatation of pevis less than 1 cm; Group II , 18 with grade 2-3 hydronephrosis with dilatation of pevis more than 1cm but less than 1.5 cm; Group III, 17 with grade 4 ~5 hydronephrosis with dilatation of pevis more than 1.5cm.
(2)The control group wtihout upper urinary tract dilation was proved by ultrasound and (or)intravenous urogram(IVU), whose mean age is 10 5y(male 34, female 17 ,range from 3m~18y) .
2 Methods:
(1)Urodynamic study: In this research free uroflowmetry, filling cystometry , pressure-flow- electromyography, urethral pressure measurement were performed in all patients according to the recommendations of the International Children Continence Society (ICCS). Urodynamic parameters inducing max free flow rate(MFR), post void residual(PVR) , maximum cystometric capacity(MCC) > neurogenic detrusor overactivity (NDOA) , detrusor-sphinc
引文
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2. Worley G,Schuster JM,Oakes WJ. Survival at 5 years of a cohort of neworn in fants with myelomeningocele. Dev Med Child Neurol 1996;38:816-822
3. Thomas Muller, Klaus Arbeiter, Christoph Aufricht. Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement theraphy and transplantation. Curr Opin Urol 2002; 12:479-484.
4. Rawashdeh YF, Djurhuus JC, Mortensen J. et al. The intrarenal resistive index as a pathophysiological marker of obstructive uropathy. J Urol, 2001, 166: 1397-1404.
5．吕宇涛，文建国，张艳等．肾脏血流阻力指数比率在评估小儿肾积水肾脏功能中的价值．郑州大学学报(医学版)，2003，38(2)：182-184．
6. Mcihel A, Pontari, Michael K, et al. Relained sacral function in children with high level myelodysplasia. J Urol, 1995,154:775-777.
7. Palmer LS, Richards I, Kaplan WE. Subclinical changes in bladder function in children presenting with nonurological symptoms of the tethered cord syndrome. J Urol, 1998,159:2131-234
8. Warder DE, Oakes WJ. Tethered cord syndrome: The lowlying and normally positioned conus. Neurosurgery,1994,34:597-600
9. Sostrin RD, Thompson JR, Routhe SA, et al. Occult spinal dysraphism in the geriatric patient. Radiology, 1997,125:165-169.
10．卫中庆，周志耀，陈承志等．隐性脊柱裂致排尿障碍的尿动力学及X线影像学研究．中华泌尿外科杂志，1998，5(19)：280-282．
11．李金良，孙小兵，陈雨历等．脊髓拴系的尿动力学表现及临床意义．中华小儿外科杂志，2002，3(23)：234-236．
12. Grignon A, Filion R, Filiatrault D, et al: Urinary tract dilation in utero: Classification and clincal applications. Radiology,1986,160:645-647.
13. Norgaard JP, van Gool JD, Hjalmas K, Hjalmas K, er al: Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol,1998, 81 (Suppl 3):1-16.
14. Schafer W, Abrams P, Liao LM, et al. Good urodynamic practices: Uroflowmetry, Filling cystometry, and Pressure-Flow studies. Neurourol Urodyna,2002,21 (3):261
15. Wen JG, Yeung CK, Djurhuus JC. Cystometry techniques in female infants and children. Int Urogynecol J Pelvic Floor Dysfunct., 2000, 11(2):103-112.
16．文建国．尿动力学检查的临床应用．郑州大学学报(医学版)，2003，38(2)：149-155．
17. Hemandez, R.D., Hurwitz, R.S., Foote, J. E, et al. Nonsurgical mangement of threatened upper urinary tracts and incontinence in children with myelomeningocele. J.Urol, 1994,153:1582.
18．文建国，郭先娥，童尔常：正常小儿膀胱压力测定．中华小儿外科杂志，1989，10(6)：347-350．
19. Kurzrock EA, Poises S. Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.J Urol 1998; 159:1657-61
20．李正，王慧贞，吉士俊主编．实用小儿外科学，北京：人民卫生出版社，2001．1153-1154．
21. Wagner W, Schwarz M, Perneczky A. Primary myelomeningoce closure and consequences. Curr Opin Urol 2002,12:465-468
22．吴阶平，裘法祖主编．黄家驷外科学．第六版．北京：人民卫生出版社．1999：1618-1619．
23．吴阶平主编．吴阶平泌尿外科学．第六版．济南：山东科学技术出版社．2001：272-274．
24. Zimmer EZ, Chao CR, Guy GP, et al. Vibroacoustic stimulation evokes human fetal micturition.Obstet Gynecol, 1993,81: 178-180.
25. Yeung CK, Godley ML, Duffy PG, Ransley PG: Natural filling cystometry in infants and children. Br J Urol, 1995,75:531-537.
26. Holmdahl G, Hanson E, Hanson M, et al. Four voiding observation in healthy infants. J Urol,1996,156:1809-1812.
27. Koff SA. Nonneuropathic vesicourethral dysfunction in children. InO'Donnell B, Koff SA(eds): Pediatric Urology. Oxford. England, Butterworth Heinemann, 1997,pp.217-228.
28．文建国，童尔昌：小儿尿流测定及其临床意义．中华小儿外科杂志，1990；11(1)：29-31
29. Bachelard M, Sillen U, Hansson S, et al. Urodynamic pattern in asymptomatic infants: Siblings of children with vesicoureteric reflux. J Urol, 1999,162:1733-1737.
30. Sillen U, Solsnes E, Hellstrom AL, Sandberg K: The voiding pattern of healthy preterm neonates. J Urol,2000,163:278-281.
31. Wen JG, Yeung CK, Chu WCW, Shit FKY, Metreweli C. Video cystometry in young infants with renal dilation or a history of urinary tract infection. Uro Res 2001; 29:249-255
32. Wen JG, Tong EC,. Cystometry in infants and children with no apparent voiding symptoms. Br J Urol. 1998;81(3):468-73.
33．文建国，童尔昌：小儿逼尿肌的非抑制性收缩．中华小儿外科杂志，1991；12(2)：96-98
34. Shokeir AA.: The diagnosis of upper urinary tract obstruction. BJU Int, 1999, 83:893-901.
35. Platt JF.: Urinary obstruction. Radiol Clin North Am, 1996, 3:1113-1129.
36. O'Reilly PH, Aurell H, Britton K, Kletter K. et al.: Consensus on diuresis renography for investigating the dilated upper urinary tract. J Nuc Med, 1996,
37:1872-1878.
37. Taylor AJr, Nally JV.: Clinical application of renal scintigraphy. Am J Roentgen, 1995, 164:31-41.
38. Conway JJ.: (Well-tempered) diuresis renography: its historical, development, physiological and technical pitfalls, and tandardiezed technique protocol. Semin Nucl Med. 1992, 22:74-84.
39. Bosniak HA, Megibow Aj, Ambos MA. et al.: Computed tomography of ureteral obstruction. Am J Roentgen, 1982, 138:1107-1113.
40. Wen JG, Ringgaard S, Frokiaer J. et al.: Contralateral compensatory kidney growth in rats with partial unilateral ureteral obstruction monitored by magnetic resonance imaging. J Urol,1999, 162(3 pt 2):1084-1089.
41．文建国．Gd-DTPA增强动态核磁共振诊断输尿管不全梗阻的实验研究．中华小儿外科杂志．2002，23：83-85．
42. Hjalmas K: Urodynamics in normal infants and children. Scand J Urol Nephrol Suppl, 1988,114:20-27.
43. Bauer SB: Pediatric urodynamics: Lower tract. In O'Donnell B, Koff SA (eds); Pediatric Urology. Oxford. England. Butterworth Heinemann, 1997,pp, 125-151.
44. Perez LM, Khoury J, Webster GD: The value of urodynamic studies in infants less than 1 year old with congenital spinal dysraphism. J Urol,1992,148:584-587.
45. Bauer SB: Enaluation and management of the newborn with myelomeningocele. In Gonzales ET. Roth D (eds): Common Problems in Pediatric Urology. St. Louis, MosbyYear Book, 1991, PP. 169-204.
46. Ghoniem GM, Roach MB, Lewis VH, et al. The value of leak pressure and bladder compliance in the urodynamic evaluation of meningomyelocele patients. J Urol 1990; 144:1440
47．杨勇，吴士良，那彦群等．脊髓拴系患者的尿动力学评估和治疗对策．中华泌尿外科杂志，2002，5(23)：267-269．
48．孙小兵，陈雨历，李金良等．尿流动力学检查对脊髓拴系诊治的临床意义．中
华脊柱脊髓杂志，2001，2(11)：114-115．
49．田军，孙宁，黄澄如等．小儿神经源性膀胱与上尿路损害，中华泌尿外科杂志，2001，7(22)：421-422
50. Simforoosh N, Tabibi A, Basiri A, et al. Is ureteral reimplantation necessary during augmentation cystoplasty in patients with neurogenic bladder and vesicoureteral reflux? J Urol,2002; 168:1439-1441
51. Schulman SL, van Gool JD: Vesical dysfunction in children. In Whitfield HN, Hendry WR, Kirby RS, Duckett JW (eds): Textbook of Genitourinary Surgery. Oxford, England, Blackwell Science, 1998, pp. 261-270
52. Stenhardt GF, Goodgold HM, Sarnuels LD. The effect of intracesical pressure on glomerular filtration rate in patients with myelomeningocele. J Urol, 1988,40:1283-1285
53. McKenna PH, Herndon CD. Voiding dysfunction associated with in continence, vesicoureteral refux and recurrent urinary tract infections. Curr Opin Urol,2000,10:599-606
54. Koff SA. Relationship between dysfunction voiding and reflux. J Urol, 1992, 148:1703-1705.
55. Stark GD. Correlative studies of bladder function in myelomeningocele. Dev Med Child Neurol 1973; 15:55-56
56. Willemsen J, Nijjman RJ. Vesicoureteral reflux and video urodyanmic studies: results of aprospective study. Urology 2000;55:939-943
57. Soygur T, Arikan N, Yesili C, et al. Relationship among pediatric voiding dysfunction and vesicoureteral reflux and renal scars. Urology 1999;54:905-908
58. McGuire EJ, Woodside JR, Borden TA et al. Prognostic value of urodynamie testing in myelodysplastic patients. J Urol 1981,126(2):205-9
59. McGuire EJ, Woodside JR, Borden TA. Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia. J Urol 1983; 129:82
60．齐艳，刘会范，文建国等．神经源性膀胱并发上尿路功能损害患者膀胱漏尿
点压的测定．郑州大学学报(医学版)，2003，38(2)：172-173
61. Bauer SB, Hallett M, Lebowitz RL, et al. Predictive value of urodynamic evaluation in newborns with myelodysplasia. J AMA 1984;252:650
62. Sidi AA, Dykstra DD, Gonzalez, R. The value of urodynamic testing in the management of neonates with myelodysplasia: a prospective study. J Urol 1986;135:90
63. Kurzrock EA, Poises S. Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.J Urol 1998; 159:1657-1661
64. Kaplan W: Disturbances of micturition: Neuropathic. In O'Donnell B, Koff SA (eds): Pediatric Urology. Oxford, England,Butterworth Heinemann, 1998, pp,229-242
65. Mclorie GA ,Perez-Marero R, Csima A. Determinants of hydronephrosis and renal injury in patients with myelomeningocele. J Urol 1988; 140:1289
66．金锡御，宋波主编．临床尿动力学，北京：人民卫生出版社，2002．101-102．
67. Quek ML, Ginsberg DA. Long-term urodynamics followup of bladder augmentation for neurognenic bladder. J Urol,2003,169(1): 195-203
68. Tufan TA, Stuart BA, Ezequiel OL, et al. Long-term followup of newborns with myelodysplasia and normal urodynamic findings: Is fllowup necessary? J Urol ,2001,165:564-567
69. Lane S, Palmer, Ingrid R, et al. Subclinical changes in bladder function in children presenting with nonurological symptoms of the tethered cord syndrome. J Urol, 1998,159:231-234
70. McGuire E J, Bloom DA, Ritchey, ML. Myelodysplasia Prob Urol, 1993,7:1
71. Edelstein RA, Bauer SB, Kelly MD, et al. The long-term urological response of neonates with myelodysplasia treated proactively with intermittent catheterization and anticholinergic therapy. J Urol, 1995,154:1500
2. Worley G,Schuster JM,Oakes WJ. Survival at 5 years of a cohort of neworn in fants with myelomeningocele. Dev Med Child Neurol 1996;38:816-822
3. Thomas Muller, Klaus Arbeiter, Christoph Aufricht. Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement theraphy and transplantation. Curr Opin Urol 2002; 12:479-484.
4. Rawashdeh YF, Djurhuus JC, Mortensen J. et al. The intrarenal resistive index as a pathophysiological marker of obstructive uropathy. J Urol, 2001, 166: 1397-1404.
5．吕宇涛，文建国，张艳等．肾脏血流阻力指数比率在评估小儿肾积水肾脏功能中的价值．郑州大学学报(医学版)，2003，38(2)：182-184．
6. Mcihel A, Pontari, Michael K, et al. Relained sacral function in children with high level myelodysplasia. J Urol, 1995,154:775-777.
7. Palmer LS, Richards I, Kaplan WE. Subclinical changes in bladder function in children presenting with nonurological symptoms of the tethered cord syndrome. J Urol, 1998,159:2131-234
8. Warder DE, Oakes WJ. Tethered cord syndrome: The lowlying and normally positioned conus. Neurosurgery,1994,34:597-600
9. Sostrin RD, Thompson JR, Routhe SA, et al. Occult spinal dysraphism in the geriatric patient. Radiology, 1997,125:165-169.
10．卫中庆，周志耀，陈承志等．隐性脊柱裂致排尿障碍的尿动力学及X线影像学研究．中华泌尿外科杂志，1998，5(19)：280-282．
11．李金良，孙小兵，陈雨历等．脊髓拴系的尿动力学表现及临床意义．中华小儿外科杂志，2002，3(23)：234-236．
12. Grignon A, Filion R, Filiatrault D, et al: Urinary tract dilation in utero: Classification and clincal applications. Radiology,1986,160:645-647.
13. Norgaard JP, van Gool JD, Hjalmas K, Hjalmas K, er al: Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol,1998, 81 (Suppl 3):1-16.
14. Schafer W, Abrams P, Liao LM, et al. Good urodynamic practices: Uroflowmetry, Filling cystometry, and Pressure-Flow studies. Neurourol Urodyna,2002,21 (3):261
15. Wen JG, Yeung CK, Djurhuus JC. Cystometry techniques in female infants and children. Int Urogynecol J Pelvic Floor Dysfunct., 2000, 11(2):103-112.
16．文建国．尿动力学检查的临床应用．郑州大学学报(医学版)，2003，38(2)：149-155．
17. Hemandez, R.D., Hurwitz, R.S., Foote, J. E, et al. Nonsurgical mangement of threatened upper urinary tracts and incontinence in children with myelomeningocele. J.Urol, 1994,153:1582.
18．文建国，郭先娥，童尔常：正常小儿膀胱压力测定．中华小儿外科杂志，1989，10(6)：347-350．
19. Kurzrock EA, Poises S. Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.J Urol 1998; 159:1657-61
20．李正，王慧贞，吉士俊主编．实用小儿外科学，北京：人民卫生出版社，2001．1153-1154．
21. Wagner W, Schwarz M, Perneczky A. Primary myelomeningoce closure and consequences. Curr Opin Urol 2002,12:465-468
22．吴阶平，裘法祖主编．黄家驷外科学．第六版．北京：人民卫生出版社．1999：1618-1619．
23．吴阶平主编．吴阶平泌尿外科学．第六版．济南：山东科学技术出版社．2001：272-274．
24. Zimmer EZ, Chao CR, Guy GP, et al. Vibroacoustic stimulation evokes human fetal micturition.Obstet Gynecol, 1993,81: 178-180.
25. Yeung CK, Godley ML, Duffy PG, Ransley PG: Natural filling cystometry in infants and children. Br J Urol, 1995,75:531-537.
26. Holmdahl G, Hanson E, Hanson M, et al. Four voiding observation in healthy infants. J Urol,1996,156:1809-1812.
27. Koff SA. Nonneuropathic vesicourethral dysfunction in children. InO'Donnell B, Koff SA(eds): Pediatric Urology. Oxford. England, Butterworth Heinemann, 1997,pp.217-228.
28．文建国，童尔昌：小儿尿流测定及其临床意义．中华小儿外科杂志，1990；11(1)：29-31
29. Bachelard M, Sillen U, Hansson S, et al. Urodynamic pattern in asymptomatic infants: Siblings of children with vesicoureteric reflux. J Urol, 1999,162:1733-1737.
30. Sillen U, Solsnes E, Hellstrom AL, Sandberg K: The voiding pattern of healthy preterm neonates. J Urol,2000,163:278-281.
31. Wen JG, Yeung CK, Chu WCW, Shit FKY, Metreweli C. Video cystometry in young infants with renal dilation or a history of urinary tract infection. Uro Res 2001; 29:249-255
32. Wen JG, Tong EC,. Cystometry in infants and children with no apparent voiding symptoms. Br J Urol. 1998;81(3):468-73.
33．文建国，童尔昌：小儿逼尿肌的非抑制性收缩．中华小儿外科杂志，1991；12(2)：96-98
34. Shokeir AA.: The diagnosis of upper urinary tract obstruction. BJU Int, 1999, 83:893-901.
35. Platt JF.: Urinary obstruction. Radiol Clin North Am, 1996, 3:1113-1129.
36. O'Reilly PH, Aurell H, Britton K, Kletter K. et al.: Consensus on diuresis renography for investigating the dilated upper urinary tract. J Nuc Med, 1996,
37:1872-1878.
37. Taylor AJr, Nally JV.: Clinical application of renal scintigraphy. Am J Roentgen, 1995, 164:31-41.
38. Conway JJ.: (Well-tempered) diuresis renography: its historical, development, physiological and technical pitfalls, and tandardiezed technique protocol. Semin Nucl Med. 1992, 22:74-84.
39. Bosniak HA, Megibow Aj, Ambos MA. et al.: Computed tomography of ureteral obstruction. Am J Roentgen, 1982, 138:1107-1113.
40. Wen JG, Ringgaard S, Frokiaer J. et al.: Contralateral compensatory kidney growth in rats with partial unilateral ureteral obstruction monitored by magnetic resonance imaging. J Urol,1999, 162(3 pt 2):1084-1089.
41．文建国．Gd-DTPA增强动态核磁共振诊断输尿管不全梗阻的实验研究．中华小儿外科杂志．2002，23：83-85．
42. Hjalmas K: Urodynamics in normal infants and children. Scand J Urol Nephrol Suppl, 1988,114:20-27.
43. Bauer SB: Pediatric urodynamics: Lower tract. In O'Donnell B, Koff SA (eds); Pediatric Urology. Oxford. England. Butterworth Heinemann, 1997,pp, 125-151.
44. Perez LM, Khoury J, Webster GD: The value of urodynamic studies in infants less than 1 year old with congenital spinal dysraphism. J Urol,1992,148:584-587.
45. Bauer SB: Enaluation and management of the newborn with myelomeningocele. In Gonzales ET. Roth D (eds): Common Problems in Pediatric Urology. St. Louis, MosbyYear Book, 1991, PP. 169-204.
46. Ghoniem GM, Roach MB, Lewis VH, et al. The value of leak pressure and bladder compliance in the urodynamic evaluation of meningomyelocele patients. J Urol 1990; 144:1440
47．杨勇，吴士良，那彦群等．脊髓拴系患者的尿动力学评估和治疗对策．中华泌尿外科杂志，2002，5(23)：267-269．
48．孙小兵，陈雨历，李金良等．尿流动力学检查对脊髓拴系诊治的临床意义．中
华脊柱脊髓杂志，2001，2(11)：114-115．
49．田军，孙宁，黄澄如等．小儿神经源性膀胱与上尿路损害，中华泌尿外科杂志，2001，7(22)：421-422
50. Simforoosh N, Tabibi A, Basiri A, et al. Is ureteral reimplantation necessary during augmentation cystoplasty in patients with neurogenic bladder and vesicoureteral reflux? J Urol,2002; 168:1439-1441
51. Schulman SL, van Gool JD: Vesical dysfunction in children. In Whitfield HN, Hendry WR, Kirby RS, Duckett JW (eds): Textbook of Genitourinary Surgery. Oxford, England, Blackwell Science, 1998, pp. 261-270
52. Stenhardt GF, Goodgold HM, Sarnuels LD. The effect of intracesical pressure on glomerular filtration rate in patients with myelomeningocele. J Urol, 1988,40:1283-1285
53. McKenna PH, Herndon CD. Voiding dysfunction associated with in continence, vesicoureteral refux and recurrent urinary tract infections. Curr Opin Urol,2000,10:599-606
54. Koff SA. Relationship between dysfunction voiding and reflux. J Urol, 1992, 148:1703-1705.
55. Stark GD. Correlative studies of bladder function in myelomeningocele. Dev Med Child Neurol 1973; 15:55-56
56. Willemsen J, Nijjman RJ. Vesicoureteral reflux and video urodyanmic studies: results of aprospective study. Urology 2000;55:939-943
57. Soygur T, Arikan N, Yesili C, et al. Relationship among pediatric voiding dysfunction and vesicoureteral reflux and renal scars. Urology 1999;54:905-908
58. McGuire EJ, Woodside JR, Borden TA et al. Prognostic value of urodynamie testing in myelodysplastic patients. J Urol 1981,126(2):205-9
59. McGuire EJ, Woodside JR, Borden TA. Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia. J Urol 1983; 129:82
60．齐艳，刘会范，文建国等．神经源性膀胱并发上尿路功能损害患者膀胱漏尿
点压的测定．郑州大学学报(医学版)，2003，38(2)：172-173
61. Bauer SB, Hallett M, Lebowitz RL, et al. Predictive value of urodynamic evaluation in newborns with myelodysplasia. J AMA 1984;252:650
62. Sidi AA, Dykstra DD, Gonzalez, R. The value of urodynamic testing in the management of neonates with myelodysplasia: a prospective study. J Urol 1986;135:90
63. Kurzrock EA, Poises S. Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.J Urol 1998; 159:1657-1661
64. Kaplan W: Disturbances of micturition: Neuropathic. In O'Donnell B, Koff SA (eds): Pediatric Urology. Oxford, England,Butterworth Heinemann, 1998, pp,229-242
65. Mclorie GA ,Perez-Marero R, Csima A. Determinants of hydronephrosis and renal injury in patients with myelomeningocele. J Urol 1988; 140:1289
66．金锡御，宋波主编．临床尿动力学，北京：人民卫生出版社，2002．101-102．
67. Quek ML, Ginsberg DA. Long-term urodynamics followup of bladder augmentation for neurognenic bladder. J Urol,2003,169(1): 195-203
68. Tufan TA, Stuart BA, Ezequiel OL, et al. Long-term followup of newborns with myelodysplasia and normal urodynamic findings: Is fllowup necessary? J Urol ,2001,165:564-567
69. Lane S, Palmer, Ingrid R, et al. Subclinical changes in bladder function in children presenting with nonurological symptoms of the tethered cord syndrome. J Urol, 1998,159:231-234
70. McGuire E J, Bloom DA, Ritchey, ML. Myelodysplasia Prob Urol, 1993,7:1
71. Edelstein RA, Bauer SB, Kelly MD, et al. The long-term urological response of neonates with myelodysplasia treated proactively with intermittent catheterization and anticholinergic therapy. J Urol, 1995,154:1500
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