Day-care ultrasound avoids urodynamics.

Abstract

Post-voiding residual urine is a common problem underlying urinary symptoms in many children often associated with infection. Tertiary referral is often made to exclude a neurological aetiology. This review reports the experience of clinician-performed ultrasound examinations in the Day-Care Unit on 50 children during a 9-month period, with various aetiologies of urinary incontinence avoiding urodynamic studies in 34. From March 1999 tertiary referral patients with urinary incontinence with or without infection and secondary referrals not responding to 'standard' management regimes, underwent clinician-performed bladder ultrasound scans in the day-care ward. A standard renal tract ultrasound examination had been reported as normal in 19 patients. In general referral had been made to exclude a neuropathic aetiology. In addition 5 patients were studied who were known to have a neurogenic bladder, 3 with an anorectal anomaly, 3 were post cystoplasty and 2 had undergone surgery for ureteric reflux. In 34 patients it was considered that a urodynamic study had been avoided, while in one results from a urodynamic study were refuted. By means of directly visualising the bladder on real time scanning, 12 children and families achieved a significantly better understanding of the relevance of residual urine in relation to symptoms, or were shown to have normal detrusor function (7), excluding a neuropathic aetiology. The three who had undergone cystoplasty were shown to have adequate bladder volumes in spite of persisting wetness. Real-time ultrasound examination of the bladder performed by a clinician in a patient-friendly environment (day-care ward) can provide significant information regarding detrusor function, often avoiding urodynamic studies. The test does not replace formal scanning for anomalies but may provide information that is masked by the more rigid environment of a radiology department, sometimes correcting results from standard urodynamic studies.