Abstract
ABSTRACTObjective: To determine if the interpretation of urodynamic studies (UDS) in children without a rectal catheter may be similar to multi-channel studies, as UDS in children are challenging and can sometimes be difficult to interpret.Patients and methods: In this retrospective pilot study, 115 paediatric pressure–flow studies were included. A blinded investigator was given two sets of UDS traces. The first set had the vesical trace of all children and the second set had the multi-channel trace. The agreement between the interpretations of both the sets was tested by Cohen’s κ, and sensitivity, specificity, and predictive values were expressed with 95% confidence intervals (CIs). The voiding pattern was compared and Pearson’s correlation coefficient was used to analyse the pressure at maximum urinary flow (Qmax).Results: The most common indications for UDS were neurogenic bladder and posterior urethral valves. The interpretation of compliance and detrusor overactivity by single-channel analysis had a positive predictive value of 92.1% (95% CI 84.7–96.1%) and 89.4% (95% CI 78.3–95.6%), respectively, and a negative predictive value of 100% and 97.1% (95% CI 89.5–99.2%) respectively, in comparison to multi-channel analysis. Children with underactive detrusor were identified reliably by analysing the straining pressure pattern and flow curve. Amongst children who voided, the pressure at Qmax showed a moderate correlation (Pearson’s coefficient = 0.53) between the two groups.Conclusion: Rectal catheters may be avoided in a carefully selected group of children undergoing UDS who only need filling phase assessment.Abbreviations: DO: detrusor overactivity; EBC: expected bladder capacity; Pabd: abdominal pressure; Pdet: detrusor pressure; PUV: posterior urethral valve; (N)(P)PV: (negative) (positive) predictive value; Pves: vesical pressure; Qmax: maximum urinary flow rate; UDS: urodynamic studies; UI: urinary incontinence
Highlights
Urodynamic studies (UDS) in children have a wellestablished role in the management of complex urological and neuro-vesical pathologies [1,2]
The placement of a rectal catheter in addition to a vesical catheter enables subtraction of abdominal pressure (Pabd) from vesical pressure (Pves), it is sometimes counterproductive in children
The incremental benefit of measuring the Pabd may be of questionable value in certain groups of patients where the only indication for this procedure is to assess bladder compliance and detrusor overactivity (DO) to decide on fluid intake, the frequency of clean-intermittent catheterisation, and anticholinergic medications
Summary
Urodynamic studies (UDS) in children have a wellestablished role in the management of complex urological and neuro-vesical pathologies [1,2]. Multichannel cystometry is currently the ‘gold standard’ for urodynamic evaluation [3]. The placement of a rectal catheter in addition to a vesical catheter enables subtraction of abdominal pressure (Pabd) from vesical pressure (Pves), it is sometimes counterproductive in children. Distress caused during the procedure often makes them uncooperative. The traces obtained are hard to interpret due to excessive artefacts. The incremental benefit of measuring the Pabd may be of questionable value in certain groups of patients where the only indication for this procedure is to assess bladder compliance and detrusor overactivity (DO) to decide on fluid intake, the frequency of clean-intermittent catheterisation, and anticholinergic medications
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