|Budget Amount *help
¥7,600,000 (Direct Cost : ¥7,600,000)
Fiscal Year 1997 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 1996 : ¥6,900,000 (Direct Cost : ¥6,900,000)
To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS-EMG) on 73 children. EUS-EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Voiding was observed in 83% of the patients. Among patients who voided, detrusor-external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients -with and without overt neurospinal defect, respectively. In children with urinary disorders, urodynamic study under GA is a feasible method for assessing EUS function and documenting DSD.
VCU findings were comparatively analyzed with DSD defined with external urethral sphincer electromyography (EUS-EMG) in 55 children (from 2 months to 14 years with a mean of 4.5 years). All children had at least I finding indicating dysfunction : 1) forceless voiding and/or intermittency, 2) rate of residual urine of greater than 20% 3 bladder tra
beculation on cystography, 4) dilatation of posterior urethra (boys) or mid-urethra (girls) on VCU.We calculated the maximal diameter of posterior urethra or mid-urethra and (PUD) the diameter of EUS (EUSD) on VCU in each children, and defined PUD divided by EUSD greater than 2 as significant urethral dilatation (UD). DSD was documented in 21 children (38%). All children with both forceless voiding and i termittency had DSD (9/9,100%), while DSD was observed om 9 of 16 (56%) children with either of them. In contrast DSD was documented only in 3 (10%) in children with normal flow. Positive rate of residuals, urethral dilatation (UD) nad bladder trabeculation were demonstrated more frequently in children with DSD than those without DSD : 71% vs 32% (P<0.005>, 93% vs 64% (P<0.005>, 71% vs 35% (P<0.001>, respectively. EUSD on VCU was significantly decreased in children with DSD compared to those without DSD(a mean of 2.0mm va 4.6mm, P<0.00001). When we defined 3mm of EUSD as the cut-off value, sensitivity, specificity positive and negative predictive value were 93%, 86% 78% and 96% respectively. DSD could be diagnosed with satisfactory accuracy by EUSD on VCU in children. Less