Study design, materials and methods
From June 2015 to January 2018 in our hospital, 29 children with neurogenic urinary bladder disease were selected. There were 13 males and 16 females, aged 1 to 15 years, with an average age of (6.1±2.72) years. In the past history, there were 12 cases of meningocele, 6 cases of tethered cords, 6 cases of intraspinal tumors, 3 cases of recessive spina bifida, 2 cases of scoliosis and vertebral spondylolisthesis. Clinical manifestations of urinary incontinence in 20 cases, 9 cases of urinary retention.
Instruments and methods
The instrument uses the GE VOLUSON E8 and the MINDRAY DC-8 Color Doppler Ultrasound System. It uses a convex array probe (frequency of 6-8 MHz) and a high-frequency linear array probe (frequency of 8-12 MHz) for joint scanning.
Under the age of 3, crying uncooperative children orally 10% chloral hydrate 0.5ml/kg body mass sedation, parents accompanying with the whole process. Subjects exposed the abdomen in supine position and scanned the bladder at the upper edge of the pubic symphysis. The oblique oblique coronal section, transverse section and longitudinal section of the bladder were observed to observe the bladder wall. The transverse section and oblique section were used to show the posterior lower edge of the bladder to observe whether the ureter was dilated. Observing the expansion of the ureteral orifice in the trigone of the urinary bladder. If the internal diameter of the ureter can be displayed, the internal diameter of the ureter can be recorded. Scan along the dissection of the dilating ureter to record the maximum internal diameter.
The degree of dilation was recorded. The bilateral kidneys were scanned. The long and short axes of the kidneys were recorded and the long diameter and the right and left diameters of the kidneys were recorded. If the renal pelvis was dilated, the anteroposterior diameter of the renal pelvis was recorded, and the presence of water in the kidney was observed. Scar formation. Finally, take a stone and use a high-frequency probe (5 MHz or more) to observe the posterior urethra and its surroundings via the perineum. All patients underwent excretion urography after ultrasound examination to see if there was vesicoureteral reflux.
Statistical method
SPSS 13.0 software was used for statistical analysis and data analysis. The count data were analyzed by two separate two-group chi-square tests. The measurement data were analyzed by two independent samples t test. p<0.05 was considered statistically significant.
Results
29 patients had 58 kidneys and 58 ureters.
1. Abnormal bladder image: A total of 26 cases (26/29, 89.6%), of which 23 cases showed trabecular and false diverticulum formation in the bladder wall, 3 cases showed thickening of the wall, less smooth, the other 3 cases No positive findings (3/29, 10.4%);
2. Ureteral vesicoureteral reflux: 9 cases (7 cases bilaterally, 2 cases unilaterally) with 16 ureteral distal end and ureterocyst entrance increased, the detection rate was 31%, and the opening diameter was (0.47±0.30) cm;
3.4 cases (3 cases bilaterally and 1 case unilaterally) had a total of 4 kidneys with scar contracture. The incidence of kidney shrinked compared with that of healthy kidneys. The incidence was 15%. All patients were confirmed to have reflux by urinary tract angiography. Ultrasound diagnosis of vesicoureteral reflux through the distal end of the ureter and the opening of the bladder has a high specificity, but it is less sensitive to children with mild primary ureteral reflux.
Interpretation of results
1. The average age of patients in this group was 6.1 years old. Due to the increased bladder filling pressure and defibrillation fibrosis, 80% (23 cases) of children had cystic changes in the bladder wall and false diverticulosis bladder fibrosis at the time of presentation. Ultrasound diagnosis can be combined with medical history at this time, after the exclusion of mechanical lower urinary tract obstruction, neurogenic bladder can be highly suspected.
2. The results of this study suggest that: Ultrasound shows that the distal end of the ureter and the entrance of the ureterocyst to expand, showing a hole-shaped, and with the ureter can change the size of the peristalsis, the above imaging characteristics of the diagnosis of vesicoureteral reflux, high specificity, consider and Detrusor muscle fibrosis and loss of elasticity are not related to the adequate supporting effect of the ureteral wall embedded in the bladder. This method is simple in diagnosing reflux and has limited conditions, but it has a low sensitivity for the diagnosis of mild vesicoureteral reflux. It is difficult to show that it is difficult to show slight expansion of the ureter, the children do not cry, and the condition of the bladder wall is complicated with the existing ultrasound technology. It is related to the difficulty of identifying openings.
3. Due to the increase of intravesical pressure, the drainage of the upper urinary tract is not smooth and the vesicoureteral reflux promotes recurrent infection of the renal parenchyma. Fibrous tissue hyperplasia leads to the contraction of the renal scar. Ultrasonography can show that the surface of the kidney is confined and the kidney is smaller than the kidney. Ultrasound in this group found 4 cases of children with kidney shrinkage, all diagnosed by urinary tract angiography there is reflux.