Hypothesis / aims of study
Urodynamic examination is one of the tests to objectively quantify lower urinary tract function. NB management guidelines and expert consensus suggest that patients should have timely and regular urodynamic examination (urodynamic test UTD) and long-term follow-up management. Previous studies have shown that UTD can effectively guide clinical management, reduce complications and improve the quality of life of patients. However, there are few reports on the difference of Utd results in patients with different etiology and course of disease and its correlation with clinical symptoms. Therefore, the UTD results of elderly patients with NB in the urodynamics examination room of the First Affiliated Hospital of Zhengzhou University in China in the past three years were analyzed and summarized in order to provide basis for the diagnosis and clinical management of elderly patients with NB.
Study design, materials and methods
57 elderly patients with NB were included. The results of urodynamic examination and clinical data, including maximum urinary flow rate (Qmax), maximum bladder volume (MCC) and residual urine volume (PRV), Safe bladder volume, detrusor overactivity, bladder sensation were collected According to the etiology, the patients were divided into 24 cases in the central nerve injury group (CNB group) and 33 cases in the peripheral nerve injury group (PNB group). According to the course of disease, they were divided into early stage (≤ 3 months), middle stage (March ~ December) and late stage (≥ 1 year).
38 elderly men (66.7%) and 19 elderly women (33.3%) were included in this study. There were 24 patients with CNB, with an average age of 68.5±5.2years old. There were 33 patients with PNB , with an average age of 68 ± 7.5 years old. There were 16 cases of detrusor overactivity in CNB group (15 cases of cerebral infarction and 1 case of intracerebral hemorrhage), and the incidence of detrusor overactivity was significantly higher than that in PNB group (66.7% vs 36.7%). There were significant differences in bladder safety capacity between CNB group and PNB group (P < 0.05). There was no significant difference in the incidence of MCC, Qmax, PRV and bladder air storage disorder between the two groups (P > 0.05). In CNB group, bladder sensation was normal in 8 cases, disappeared in 4 cases, decreased in 10 cases and sensitive in 2 cases; In PNB group, bladder sensation was normal in 9 cases, disappeared in 8 cases, decreased in 14 cases and sensitive in 2 cases. There was no significant difference in safe bladder volume between patients with different bladder sensation (P > 0.05).
Interpretation of results
The results show that CNB patients are more likely to have overactive detrusor and reduced safe bladder capacity in the early stage, which is consistent with the relevant literature. On the one hand, the nerve pathway above the brain stem is damaged. Although the nerve reflex pathway of the lower urinary tract is complete and does not change the neurophysiological characteristics of detrusor contraction during micturition, the cerebral cortex cannot perceive bladder filling and can not control micturition at will. When the detrusor contraction occurs, the myoelectric activity of the external sphincter of the urethra disappears and reflex micturition occurs in most patients. On the other hand, the outlet of the urethra The decline of muscle strength, abnormal muscle tension or dyskinesia of pelvic floor muscle denervation are also important factors, but there are few pelvic floor research data for such patients.