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Clinico-Anamnestichesky and urodinamicheskie research methods.

According to mediko-economic standards of rendering of medical aid, inspection of children with disturbances MI was all-round and complex, it included obshcheklinicheskie methods (the anamnesis collecting, physical inspection, laboratory blood analysises, urine), ultrasonic research (ultrasonic) of kidneys and MT, a X-ray-urological of research of organs mochevydelitelnoj systems (ekskretornaja urography and cystography) with a contrast agent ("Omnipak", "Vezipak", "Ultrawhist", "Skanljuks", "Urografinum"), urofluometriju (UFM), an electrocardiography (electrocardiogram), consultation of experts (the neurologist, the urologist, the gynecologist), consultation of the clinical psychologist (conversation with the child and his parents, filling of specialised psychological questionnaires, performance of psychological tests and tasks). In the presence of indications to children tool methods of research (retrograde tsistomanometrija, profilometrija, cystoscopy), and also UFM with carrying out of pharmacological assays were carried out.

As materials, the conclusions of doctors-experts, reports of researches, mark questionnaires according to clinical characteristics of an emiction (on E.L.Vishnevsky, 2001 and on A.B.Moiseyev, 2003-2008), diaries «Dry and wet nights», emiction rhythms, reports of sessions FBU - therapies case histories served in regimen EMG.

The biochemical blood analysis was spent to laboratories Izmajlovsky DGKB on automatic analyzer METROLAB 2300 (Argentina) by a technique applied on the equipment with use of the reactants recommended by the manufacturer by managing clinical laboratory N.JU. Fedotovoj to which we express gratitude. The estimation of following indicators was made: the general fiber, urea and a creatinine, blood serum electrolytes.

Ultrasonic research of kidneys and MT as the least invasive method of inspection was spent to all observable children on apparatus Volution 730 Pro and Hitachi Eub-565A konveksnym by the gauge with frequency of 5,5 MHz (and possibility of use of function colour doplerovskogo kartirovanija with definition of a renal blood flow and a resistance index (IR) vessels of kidneys) doctors of ultrasonic diagnostics
Izmajlovsky DGKB k.m.n. E.V.Faustovoj, G.M.Martemjanovym and k.m.n. M.M.Kolisnechenko to whom we express gratitude.

X-ray-urological inspection (ekskretornaja the urography and cystography) were carried out under indications for the purpose of revealing (specification) of various anomalies of development and a structure, and also disturbance of function from various departments of system of organs MVS (kidneys, ureters, a bladder, mocheispuskatelnyj the channel). Research was spent by means of apparatus Continental TM 50 RF (radiological pipe Eureka Linear MC-150) with use of contrast preparations "Omnipak", "Vezipak", "Ultrawhist", "Skanljuks" and "Urografinum" in age dosages (managing unit of radial and ultrasonic diagnostics Izmajlovsky DGKB V.I.Lazarenko).

At the present stage the all-round analysis of anamnestic data on disturbances MI and NDMP, results of registration of rhythms spontaneous MI, filling of specialised mark questionnaires, scoping of a residual urine by means of ultrasonic, for obektivizatsii results of inspection have been added urodinamicheskim by inspection which allows to tap character and degree of expression of available disturbances, and also to carry out the control of efficiency of spent therapy.

Urodinamichesky inspection begin with urofloumetrii, as most physiological and least invasive method of an estimation of a phase oporozhnenija MT. Urofloumetrija (grech. uron - urine, English flow - a stream, a stream and grech. metrio - to measure, measure) is a non-invasive method of direct graphic registration of dynamics of the expense of urine for a time unit (a volume flow rate of urine) during the physiological certificate MI, totally reflecting a functional condition detruzora (a tonus, sokratitelnaja activity) and passableness (resistance) mocheispuskatelnogo the channel [64, 136, 314].

For today urofloumetricheskaja the equipment should meet strict demands: simplicity of operation, absence of necessity for frequent calibration, accuracy and reliability of registration of a flow rate of urine, the minimum delay of time from the beginning of a stream before its registration, the general error of measurement - 2 % and less, the minimum sensitivity of the measuring block to physical and chemical properties of urine (temperature, rn, density etc.), possibility of the organisation of physiological certificate MI (sitting or standing), an exception of presence of the medical personnel during research (at such necessity), simultaneous measurement of a flow rate of urine and effective volume of MT, possibility of carrying out combined urodinamicheskih researches, a measuring range of rate within 0-60 ml/SEC and effective volume of MT from 0 to 1500 ml, and also the automated calculation uroflougramm upon termination of research [55, 243, 287, 317, 324].

Considering high informativnost a method and its minimum invasiveness, urofloumetrija it was carried out to all surveyed children with disturbances MI (153 of the basic group and 102 of comparison group). Research was spent on the basis of a nephrology unit Izmajlovsky DGKB A.N.Sazonov's by urologists and k.m.n. M.G.Petrovoj, medical sister urodinamicheskogo S.N.Beljaevoj's office to which we express gratitude, on AKK СУРД-01 "Relief" by a technique of the manufacturer of the device
(Innovative medical enterprise "Веста", Vladivostok »). A key component of"Relief"is its software -"Urovest", executed according to demands of Ministry of Health of Russia, allowing in an expanded variant to process and submit data urodinamicheskih researches. It is important, that the given version of the software supports a format of storage of records of the previous program«Уротест-51».

Feature urofloumetrii is that it is necessary for carrying out before carrying out of various intraurethral and intravesical manipulations, at full psychological comfort from the patient. Last aspect is very important, as the result of procedure in many respects depends on it, after all the child should urinate in conditions unusual to: without a habitual toilet bowl, in the presence of the special device, at presence (let and behind a screen) extraneous persons - the medical personnel (its presence in pediatric practice at the moment of research is proved by behavioural and age features of children). For putting off of a psychological strain to the child explain a course of diagnostic procedure, if necessary is short acquaint with principles of work of the equipment, a door of a handling office close from within, on which outside krepjat the tablet: «Attention! There is a research! Without the invitation not to enter! On a door not to knock!» . For personification of data urofloumetrii, before the procedure beginning on each patient the individual file in which in memory of the computer results of the carried out research will be stored is in electronic form got.

At carrying out (standard - as independent method of research) urofloumetrii at desire occurrence to miktsii the child ask to empty MT in a funnel urofloumetra, in position habitual for it (girls - sitting, boys - standing). Urofloumetr it joins and switched off independently in the beginning and in the end of certificate MI, accordingly. AKK in an automatic regimen analyzes data urofloumetricheskoj a curve in dynamics with delivery of results on the screen and their entering into memory of the computer. For recording of the carried out research, graphic and figures are unpacked on a paper for what to AKK СУРД-01 "Relief" is connected the printer. Further the estimation received urofloumetricheskih data is spent by the urologist. It is necessary to notice, that for rising of reliability of results urodinamiki the bottom urinary ways to a phase oporozhnenija urofloumetriju it is expedient to spend not less than 2-3 times within days.

Urofloumetrija is one of few non-invasive researches according to a functional condition of the bottom department of the urinary tract, allowing to tap at patients obstructive and-or neurogenic disturbances, and also to check dynamics of pathological process and efficiency of medicinal therapy and-or operative treatment of disorders MI. However it is necessary to remember, that urofloumetrija as monoresearch maloinformativno for diagnostics of a concrete pathological condition of the bottom department of urinary ways. Received at urofloumetrii the information has paramount value for verification of type MI which are sectioned on normal, prompt, obstructive, intermittent, interrupted, depressive. Data about type MI should be supplemented with digital value,
Leading value among which take away the maximum volume flow rate, and also clinical data [64, 110, 124, 324, 327].

For interpreting uroflougramm use qualitative and quantitative ways of an estimation. At quality standard uroflougramm are guided by the sum of the symbolical signs registered in a curve of the schedule of research on which reliability with certain degree assume this or that pathological condition of the bottom department of an urinary tract, that is define types MI.

At normal type of an emiction at healthy people (without dependence from a floor and age) the stream schedule has a configuration reminding under the form a bell or gaussovskoe distribution, with ascending and descending segments. As the maximum value of a stream is necessary on an initial third of time MI and approximately on the middle of quantity of the allocated urine the schedule becomes a little azygomorphous. As a result ascending segment uroflougrammy gets a little big steepness, rather than descending. At given type MI quantitative characteristics MI (high-speed and time) correspond to age norm.

Prompt type of an emiction (or a superstream) regard as urodinamicheskuju anomaly because oporozhnenie MT occurs very quickly. Thus high-speed and time characteristics MI differ from norm: the maximum expense of urine - more than 40 ml/SEC (in some cases reaches to 70-100 ml/SEC), and time MI - some seconds. Uroflougramma unlike normal (the form of slightly azygomorphous bell) sharply changes - is enlarged in height and decreases in the basis (a kind of the scorched tree - a trunk without branches and a crone).

At obstructive type of an emiction depression of a flow rate of urine of various degree of expression becomes perceptible, however in some cases digital characteristics of a stream of urine within the certain period of time can correspond to age norm. Characteristic qualitative signs of most often meeting variants of obstructive type MI are: a smoothness of ascending and-or descending segments and some uploshchenie uroflougrammy, expressed uploshchenie uroflougrammy at the expense of depression of the expense of urine for a time unit and time augmentations miktsii, shift of peak of the maximum flow rate of urine to the right for a while exceeding first third MI, and also stratification of signs of other types MI (interrupted or intermittent).

The intermittent type of an emiction is portsionnoe allocation of volume of the urine, registered on uroflougramme in the form of a wavy curve. Thus against usual dynamics of a stream there are episodes of augmentation or the decreases of its rate which are growing out of applying of active fluctuations of intraabdominal pressure upon physiological reduction detruzora, and also because of participation in process oporozhnenija MT of extracystic structures - muscles of a forward abdominal wall.

The interrupted type of an emiction is characterised by that the urine stream periodically interrupts completely, and it urodinamicheskie characteristics decrease on uroflougramme to zero. Thus oporozhnenie MT represents a series separate miktsy with insignificant effective volume in
The big range of rates of 2-20 ml/seconds the Given type MI arises at a decompensation detruzora a neurogenic or obstructive parentage, oporozhnenie MT as a result occurs exclusively with the assistance of muscles of a forward abdominal wall («an abdominal emiction»).

The depressive type of an emiction is defined only at carrying out out-patient urofloumetricheskogo monitoring, what not identically standard urofloumetrii, carried out in the limited piece of days. In particular, at given type MI the minimum and maximum volume of is single-step allocated urine differ less than five times. From three basic types MI: normal, prompt and obstructive (with its variants), last is the diversified (for the occurrence reasons, a current and ambiguity of the forecast without dependence from a floor and age of the patient).

Among the factors conducting to formation of obstructive type MI, allocate the following: detruzornye, arising owing to depression or full absence of reductions detruzora at development of pathological processes outside of MT (a myelodisplasia, onkoproliferativnye, inflammatory, vascular and is degenerate-destructive diseases, ishemicheski-okkljuzionnye disturbances of a circulation of organs of a small basin, etc.), urethral, formed because of a mechanical obstacle of urethral passableness, and combined [55, 64, 121, 324].

The quantitative analysis uroflougramm, thanks to the International committee on standardization urodinamicheskih researches, is spent by the uniform principle taken as a principle of work of computer programs for urofloumetrov and urosistem, automating all investigation phases - from including and deenergizing of the device, calculation of time and high-speed characteristics of a stream of urine and their digital representation. As a result, quantitative data (volume of the allocated urine, time of delay MI, time MI, rate for the first second, time of achievement of the maximum stream of urine, the maximum volume flow rate of urine, an average volume flow rate of urine, factor Kh) became comparable and have ceased to depend on laboratory where them have received. The given indicators are important for an integrated estimation urofloumetrii, therefore we will stop on their description in more details. The volume allocated mochiili effective volume of a bladder is a volume of urine (without residual) which is allocated during MI (V, ml). For obektivizatsii results urofloumetrii it is desirable, that the volume of the allocated urine was not less than 100 ml. Delay time (delays or expectations) emictions - time from the moment of readiness of the patient to make MI before occurrence of a stream of urine (t, sec). Emiction time is a time interval from beginning MI before allocation of 95 % of the measured volume (t, sec). Rate (urine) for the first second - represents the volume of urine allocated for the first second MI (QiceK, ml/SEC). Time of achievement of the maximum stream of urine is a time interval from the beginning of allocation of urine till the moment of achievement of the maximum flow rate or «emiction peak» (іомиг, sec). The maximum volume flow rate of urine is an allocation of the maximum volume of urine in unit of time or the maximum value of a volume flow rate of urine (Qwikv, ml/SEC). An average volume flow rate of urine - average value of a volume flow rate or urine volume for a time unit, defined as private from division of effective volume of MT (in ml) for a while
MI (in sec) (Q ^, ml/SEC). Factor Kh (V.V. Danilov, 2001) reflects the relation of an average volume flow rate of urine to the allocated volume and allows to compare uroflougrammy to any volumes that is rather actual in pediatric practice. In norm factor Kh from fluctuates in limits from 0,3 to 0,6 [55, 74, 121, 138].

On purpose obektivizatsii estimations received in a course urofloumetrii data for children of various age have been developed standard value of some quantitative characteristics uroflougramm (V.M.Derzhavin, I.V.Kazan, E.L.Vishnevsky, B.S.Gusev, 1984), presented in table 1.

Table 1 - Indicators uroflougrammy for children of 4-14 years (on V.M.Derzha іі in іііі at and co-workers., 1984) *

Key parametres uroflougrammy Sex of a child
Girls Boys
Effective volume of a bladder
To 200 ml More than 200 ml To 200 ml More than 200 ml
Duration MI (in sec) 11,0 yo 1,7 16,5 yo 1 11,8 yo 0,6 22,7 yo 2
Average flow rate of urine (ml/SEC) 11,0 yo 1,6 17,8 yo 1,4 8,4 yo 0,5 14,9 yo 1,6
Rate of a current of urine in the first second (ml) 9,7 yo 1,6 9,2 yo 1,6 10,0 yo 1,1 9,7 yo 1,4
Time of achievement of the maximum rate of a current of urine (sec) 3,9 yo 0,7 5,8 yo 1 4,2 yo 0,3 8,7 yo 1,5
The maximum rate of a current of urine (ml/SEC) 19,7 yo 2 31,0 yo 1 19,6 yo 0,7 26,2 yo 1,8

* Vishnevskij E.L., Gunner D.JU., Loran O. B, etc. Urofloumetrija. - M: the Printing city, 2004.

For rising of diagnostic possibilities urodinamiki attempts updating standard urofloumetrii were repeatedly undertaken. One kinds modified urofloumetry (differentiated, radioisotope, gas, etc.) Have only historical value, others - as farmakourofloumetrija have taken a worthy place in diagnostics of a pathology of distal departments of an urinary tract. In an integrated estimation of passableness of an urethra well itself assay with Furosemidum, the employee for revealing of reserve possibilities of urinary ways at infravezikalnoj has recommended obstructions, and in dynamics - for definition of severity level of obstructive disturbances urodinamiki (A.J.Pytel, V.V. Borisov, 1997). In Izmajlovsky DGKB thanking k.m.n., to senior lecturer O.B.Kolbe it was activly applied farmakourofloumetrija from M - by cholinolytics (oksibutinin, atropine), a neostigmine methylsulfate, Mydocalmum which allows to lower and optimise number of invasive diagnostic procedures, and also obosnovanno to approach to selection of medicinal therapy and tactics of conducting patients [73, 76, 111, 112, 324].

It is necessary to notice, that at practically healthy people of any age and a floor the maximum flow rate of urine (its expense for a time unit) fluctuates in exclusively wide range of sizes, therefore, despite clinical appeal of a method and seeming simplicity of performance urofloumetrii, interpreting uroflougramm is not deprived complexities (underestimation of is qualitative-quantitative data, hyperdiagnostics etc.) [12, 64, 72, 124, 324].

For diagnostics of functional disturbances of MT (under indications) are used retrograde tsistomanometrija and residual urine scoping. Retrograde tsistomanometrija represents
Method of graphic registration of pressure in MT during all period of its filling. Sensitivity, reflex excitability and adaptic properties of MT the parity of indicators reflects pressure/volume. Retrograde tsistomanometrija also it was spent on multipurpose AKK СУРД-01 "Relief". Before performance tsistomanometrii to the child explain a research course, then suggest to urinate. Make processing of genitals of 1 % an aqueous solution of a dermal antiseptic - hlorgeksidina, into MT enter sterile catheter Foleja №№ 8, 10 (depending on age), define residual urine volume. Then, using a tee, the gauge of pressure and system for nonlinear filling of MT with a liquid bridge to the external extremity of a catheter. In system to nonlinear filling of MT as a liquid apply a normal saline solution. After checking and testing AKK СУРД-01 "Relief", with small rate of filling (no more than 40 ml/mines) in MT enter a liquid. Simultaneously on "Relief" include a regimen "TSistometrija". At occurrence at the child of desires to MI (the first and the second (imperative)) on screen AKK mark («+»). The patient ask to urinate. TSistometriju carry out consistently in two prone positions and sitting. The Urodinamichesky system in an automatic regimen processes data (pressure and MT volume at the first and the second (imperative) desires on MI, measured in mm of a water column and in ml, accordingly, and also the tonometric index (in mm/ml), an indicator of adaptation of MT, expressed in percentage of ideal norm, a parity pressure/volume in dynamics, then AKK builds a graphic representation - tsistotonogrammu [74, 75, 76, 90, 121, 150, 261].

Residual urine scoping in MT can be made by means of MT catheterization, ultrasonic (or radioisotope) methods.

Thus, disturbance rezervuarno-evakuatornoj function of MT demands performance all-round and complex urodinamicheskogo inspection for specification of a functional condition of an organ, its sphincters and selection of adequate ways oporozhnenija. Absence of highly effective and universal ways of treatment of patients with functional disturbances of accumulation and oporozhnenija urine dictates necessity of search new and modernisation of used methods of treatment.

For obektivizatsii verifications of various disturbances of distal department of an urinary tract in our research the standard terminology recommended by the International committee on standardization urodinamicheskih of researches is used: daily quantity of urine (diuresis), a physiological emiction, oligourija, a nocturia, a residual urine, a pollakiuria (true and false) [52, 53, 55, 82, 95, 296].

For intepritatsii the received data standard value of daily and single volumes of urine, and also frequency MI at children of various age who are presented in table 2 (on A.V.Papajan and N.D.Savenkovoj, 1997) are used.

Table 2 - Daily and single volumes of urine, and also frequency MI at children depending on age (on A.V.Napajan and N.D.Savenkovoj, 1997) *

Age Daily quantity of urine, ml Single quantity of urine, ml Quantity MI for days
To 6 months 300-500 20-35 20-25
6 months - 1 year 300-600 24-45 15-16
1 - 3 years 760-820 60-90 10-12
3 - 5 years 900-1070 70-90 7-9
5 - 7 years 1070-1300 100-150 7-9
7 - 9 years 1240-1520 145-190 7-8
9 - 11 years 1520-1670 220-260 6-7
11 - 13 years 1600-1900 250-270 6-7

* Papajan A.V., Savenkova N.D.clinical nephrology of children's age. - SPb.: the lefthander, 2008.

As the excitation threshold of the receptor apparatus of MT influences formation of a vesical reflex, which redstavljaet itself reduction detruzora and a relaxation of sphincters of a bubble in reply to a stretching of its walls in certain volume of urine now allocate normo - gipo - hyper-and asensornyj MT types. The bladder is considered normosensornym (normoreflektornym) when MI arises at achievement srednefiziologicheskogo urine volume. At hyposensory (hyporeflex) MT a bubble miktsija it is carried out, if the urine volume exceeds the top border of age norm, and at hypersensory, - on the contrary, when volume of urine less than the bottom border of age norm. For asensornogo (areflektornogo) MT absence independent MI owing to a pathology of sensitivity of receptors and-or reflex disturbance is characteristic.

Estimation of an eisodic (sensitive) innervation of MT in nefro-urological practice carry out on a desire which represents sensation of filling of MT, arising at a stretching detruzora urine and achievements of a threshold of sensitivity. In the absence of MI the desire progradientno accrues with periodic peaks of activity and for some time can be suppressed effort of will (activation of muscles of a perineum and an external sphincter) for oporozhnenija MT in socially comprehensible conditions. In some cases the heavy feeling and-or pains in the field of MT projection, arising at the maximum filling of the last can be a desire equivalent on MI. The desire on MI can be strengthened or weakened. A vivid example of the strengthened desire is the imperative desire. It represents periodically arising and accruing insuperable sensation of necessity MI. And time from the moment of occurrence of a desire to obligatory, often uncontrollable MI, is dynamically reduced. For the purpose of cupping of an imperative desire children and adults can use various behavioural receptions: the trunk inclination forward with a strain of muscles of a perineum and breeches, a crossing of feet, squeezing of area of a perineum by arms, a heel, an artificial boring of genitals etc. For the weakened desire harakternyredkie miktsiipri it number MI for children is more senior 5 years less than five times a day.

Frequent implication of disorders MI is the incontience of urine which is characterised by the consensual (uncontrollable) efflux of urine from MT through an urethra (a vesical incontience of urine)
And-or other channels, for example, fistulas (ekstravezikalnoe an urine incontience). According to modern classification allocate some types of a vesical incontience of urine [6, 82, 101, 182]:

1. The stressful incontience of urine (SNM) (about 40 % of all cases of an incontience of urine) is consensual (without a previous desire) the efflux (podtekanie) urine during an exercise stress, at natuzhivanii, laughter, tussis, change of position of a body and the other conditions accompanied by rising of intraabdominal pressure. Most often SNM develops because of delicacy of muscles tazovogo bottoms therefore the neck of MT and an urethra become excessively mobile. As a result at rising of intraabdominal pressure the force influencing walls of MT, starts to exceed possibilities of compression of an external sphincter of an urethra, intravesical pressure prevails over urethral, that conducts to the efflux (podtekaniju) urine.

2. An imperative incontience of urine (urgentnoe, acute or neuderzhanie urine) (25 % of cases) - consensual allocation of urine against an imperative (uncontrollable) desire on MI, caused by hypersensory (hyperreflex) dysfunction of MT. The given type of disturbance MI is bound to consensual reductions detruzora, called by instability detruzora more often.

3. The admixed incontience of urine (27 % of cases) - includes a combination of symptoms stressful and imperative an urine incontience.

4. An incontience of urine from overflow, an inconscience with overflow (5 % of cases) - consensual allocation of urine on drops or podtekanie urine owing to MT overflow. Thus independent MI is not present, and in MT the residual urine considerable quantity regularly remains. The given type of an incontience in a thicket is caused by presence expressed infravezikalnoj obstructions (for example, the urethra valve, a good-quality hyperplasia of a prostate etc.).

5. A reflex incontience of urine (3 % of cases) - the consensual, regularly coming allocation of urine arising because of spontaneous reduction detruzora, owing to dissociation of an intact cone and epikonusa a spinal cord with overlying departments TSNS and formation of the raised spinal reflex. The lesion of a spinal cord with development of full cross-section damage of spending ways can be bound to an acute trauma, a tumour or a cross-section myelitis etc., settling down above a lumbar thickening.

Allocate also a syndrome of an imperative emiction (THESE) - a symptom-complex including a pollakiuria, imperative desires and an imperative incontience of urine.

To disturbances MI bound to an incontience of urine, researchers carry an uracrasia. The uracrasia - consensual MI during a dream (more often night, is more rare day), at children at age when there should be a control over MT (on domestic sources is 5 years, on foreign - 6 years). For today the majority of researchers are convinced of a generality of an aetiology and a pathogenesis by THESE and an uracrasia. Unlike an uracrasia shown in a dream, the urine incontience (stressful, imperative, owing to overflow etc.) arises during wakefulness, that is against the high activity of a brain supporting consciousness and
Purposeful behaviour of the person. Probably, what exactly because of this fact an uracrasia have not included in THESE [101, 204, 285, 298].

Allocate following basic forms of an uracrasia:

• the Simple form - at it arise constant, but rare (2-5 times a week) episodes of an incontience of urine during a dream, in most cases very deep (profundosomnija), independent of quantity of the drunk liquid. After consensual MI in bed the child does not wake up. It is interesting, that at the given form of an uracrasia consensual MI arises not it (is overflowed), and in first half of night in the morning when MT is filled, it is frequent at the first 2-3 o'clock of a dream. Thus the family anamnesis on an uracrasia is in most cases burdened, but neurologic and urological pathological symptoms at inspection are not taped. Children are indifferent to the pathology, supersede, ignore it.

• the Neurotic form is characterised by a wavy current and strongly pronounced negative emotions of the child in relation to the problem, reaching sometimes before suicidal intentions. To this form of the uracrasia, developing during the critical age periods (in 3, 5 or 7 years) as reactions to an acute and-or serious psychological trauma, often precede, and accompany further various neurotic implications (irritability, aggression, emotional lability, kapriznost, tearfulness, dream disturbances, habit spasms, pavors, phobias and so forth). A dream uneasy, with night pavors. At the given form of an uracrasia there is a direct dependence between occurrence of emotionally significant situations for the child and frequency of episodes MI in a dream.

• the Endokrinopatichesky form - a combination of a night uracrasia to a diencephalic pathology and endocrinopathies: a diabetes, adiposity, paroksizmalnymi temperature liftings and so forth

• the Epileptic form (an epileptic uracrasia) - is rather original, as consensual MI is carried out with allocation of a considerable quantity of urine for short time («urinary explosion»), is accompanied by short-term respiratory standstill, small twitchings of extremities and vegetative disturbances and arises at an epilepsy, thus during complex neurologic inspection the fine focal semiology is taped.

• the Nevropatichesky form (nevropatichesky the uracrasia) is formed against a neuropathy developing as a result of not rasping changes of the central and peripheric nervous system, frequent catarrhal diseases at early age, is often accompanied by dream disorders, disturbance of a biorhythm a dream - wakefulness. At nevropaticheskoj to the uracrasia form the combination consensual MI in a dream, with speeded up miktsijami, imperative desires and an incontience of urine during the wakefulness which frequency is considerably enlarged at catarrhal diseases becomes perceptible.

• the Dysplastic form arises at an organic lesion of the centres of regulation MI in spinal (for example, spina bifida) and a brain that is shown besides an uracrasia by a day incontience of urine
And a feces incontience (enkoprez). MI it is carried out consensually in process of MT filling, and children do not feel neither a desire, nor the urine efflux, feces allocation.

• the Neurosis-like form (a neurosis-like uracrasia) - this term unite dysplastic and nevropaticheskuju to uracrasia forms, when there is a disturbance of stages of a dream and rasping changes of bioelectric activity of a brain (irritativnyh, focal, epileptiform), confirmed with electroencephalogram data. This form of an uracrasia is often combined with the minimum cerebral dysfunction, a stammering, a habit spasm, pavors and phobias, and frequency of episodes of an uracrasia directly is bound to quantity of the drunk liquid. Children concern the pathology adequately or indifferently, but without the expressed emotional colouring [25, 47, 68, 182, 227, 296].

Allocate a primary and secondary uracrasia. A primary (persistent) uracrasia - the most widespread form of an incontience of urine (among children of younger age) at which period «dry nights» at the child were not absolutely or its duration did not exceed 80-90 % of cases the Primary uracrasia is sectioned 6 months on monosimptomnuju and polisimptomnuju forms. At monosimptomnoj to the form an urine incontience in a dream remains since a birth, but without accompanying symptoms of organic, neurologic or mental disturbances. polisimptomnaja the form - the complicated uracrasia, is formed at accompanying nefro-urologicheskiih, neurologic, mental or endocrine diseases. At secondary (got, recurring) an uracrasia consensual MI in a dream arise after the previous period of "dry nights», communication with various nefro-urological, neurologic, mental and endocrine diseases [49, 159, 161, 182, 218, 227] is available duration from 6 months till several years, thus.

For diagnostics and an estimation of degree of expression of a syndrome imperative MI (THIS), and also obektivizatsii results of spent therapy throughout last 10-12 years successfully use the table, the developed E.L.Vishnevsky (table 3) [53, 56, 136].

Table 3 - the Table of an estimation of a syndrome imperative MI (ate Vishnevsky from co-workers., 2001) *

№ p/p Signs Condition Points
1 Imperative desire on No 0
Emiction Not every day 1
Every day - 1-2 times 2
Every day - some times 3
2 Imperative incontience No 0
Urine Not every day 1
Every day - 1-2 times 2
Every day - some times 3
3 The consensual No 0
Emiction during time Not every month 1
Night dream (uracrasia) Some times in a month 2
Some times in a week 3
Every night 4
Every night - some times 5

Table 3 continuation.

4 Emiction rhythm A.Chislo of emictions a day
5-8

9-10

11-12

13-14

15-16

17-18

19-20

20 and more

0

1

2

3

4

5

6

7

Emiction rhythm B.Sredny effective volume of the urinary Bubble, ml
Bladder volume, ml Age, years
4-7 8-11 12-14
To 50 4 5 6
51-75 3 4 5
76-100 2 3 4
101-125 1 2 3
126-150 0 1 2
151-175 - 0 1
176-200 - - 0
5 Diuresis from 18 o'clock till 6 o'clock (on To 40 0
To the relation to daily allowances, %) 41-50 1
51-60 2
61-70 3
More than 71 4
6 Leukocyturia No 0
In the urine analysis on nechiporenko 1
In the general analysis of urine 2
3

Score:

* Vishnevskij E.L., Loran O. B, Vishnevsky A.E.clinical an estimation of disorders of an emiction. - M: the TERRA, 2001.

For an estimation of the received data after table 3 filling count up a score which can fluctuate from 0 to 45. By quantity of the typed points define severity level THESE: easy (1-10 points), average (11-20 points) and serious (more than 20 points). Also by means of table 3, using data of average effective volume of MT, with high degree of reliability it is possible to draw a conclusion on presence at the patient normo - gipo - hypersensory type of MT.

As have shown our observations, clinical implications of pathology MI are not always bound to digital indicators urodinamicheskih and clinico-laboratory methods of inspection. For filling of the table of an estimation with THESE to the doctor documentary confirmed data of results of inspection (urofloumetrija, ultrasonic, the general analysis of urine, the urine analysis on nechiporenko) are required, that extremely limits its use at the primary collecting of the anamnesis and in express diagnostics of pathology MI. Besides table 3 considers a pathology exclusively MVS, ignoring disturbances from distal departments GASTROINTESTINAL TRACT (constipations, enkoprez), as a rule, proceeding in common in a kind sochetannogo function disturbances tazovyh
Organs (SNFTO). It has given preconditions for working out of the new table named by us «the Nephrological questionnaire» (A.B.Moiseyev from co-workers., 2003-2008) (table 4 [145]).

Table 4 - Nephrological опросіик (A.B.Moiseyev from co-workers., 2003-2008)

Familija I.O. of the child Age
Symptoms Estimation, implication Points Age of occurrence of symptoms/beginnings of disease
AND
1. Whether there is at the child an uncontrollable desire to an emiction («it is necessary more likely in a toilet»)? No 0 0
Not every day 1 1
Every day - 1-2 times 2 2
Every day some times 3 3
2. The child cannot constrain a desire on an emiction («misses urine»)? No 0 0
Not every day 1 1
Every day - 1-2 times 2 2
Every day some times 3 3
3. Whether there is at the child an incontience of urine during a night and-or day dream (necessary to underline)? No 0 0
Not every month 1 1
Some times in a month 5 5
Some times in a week 10 10
Every night - 1 time 15 15
Every night - some times 20 20
4. How many time the child is wetted within day (days)? 1-2 8 8
3-4 9 9
5-8 0 0
9-10 1 1
11-12 2 2
13-14 3 3
15-16 4 4
17-18 5 5
19-20 6 6
20 ibolee 7 7
5. The child misses urine at laughter, tussis, an exercise stress (necessary to underline)? No 0 0
Not every day 1 1
Every day - 1-2 times 2 2
Every day some times 3 3
6. Whether constipations become perceptible at the child? If "yes", to skolkih days? No 0 0
1-2 days 1 1
3-4 days 3 3
5 and more days 5 5
7. Whether there is at the child a feces incontience (kalomazanie)? No 0 0
Not every day 5 5
Every day - 1-2 times 10 10
Every day some times 20 20
8. Whether the diagnosis «neurogenic dysfunction of a bladder» and-or «detruzorno-sfinkternaja a dyssynergia» is established to the child? No 0 0
Hyporeflex dysfunction 1 1
Detruzorno-sfinkternaja

Dyssynergia

2 2
Hyperreflex dysfunction 3 3

Table 4 continuation.

9. The child suffers a chronic pyelonephritis and-or a cystitis (necessary to underline)? How often there are exacerbations? No 0 0
Once a year 1 1
2 times a year 2 2
More than 2 times a year 3 3
10. Whether treatment of the child concerning an incontience of urine and-or a feces, constipations (necessary to underline) was spent earlier? What was effect from treatment? No 2 2
Was spent, has recovered 0 0
It was spent, effect unstable 5 5
It was spent, without effect 10 10
Score

The score in table 4 fluctuates from 0 to 79. Criteria of an estimation of the received results - are similar to table 3: 1-10 points - easy degree of disturbances, 11-20 points - average degree of disturbances, more than 20 points - high degree of disturbances. For possibility of an estimation of results in dynamics the column "Points" consists of two columns "And" and which, accordingly, are filled in the beginning and in the end of treatment. Questions in «the Nephrological questionnaire» have the accessible formulation and are whenever possible deprived medical terminology for the purpose of its use not only doctors, but also parents, children-teenagers (under the control of the medical personnel).

2.1.2.

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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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