Pictorial Urgency Scale – A New Tool for Evaluating Bladder Urgency in Children

Abstract

PurposeBladder fullness and urgency are difficult to express for some patients. We hypothesized that images on a pictorial urgency scale would correlate with International Continence Society (ICS) standard verbal descriptors and bladder volume. Materials and MethodsAim 1. Toilet trained children and their parents were tested, excluding those with a history of urinary infection, voiding dysfunction, genitourinary surgery or reflux. Subjects were read each of the four descriptors and asked to point to an image. Correlation between descriptors and figures was analyzed using a mixed effects proportional odds logistic regression model. Aim 2. Children undergoing voiding cystourethrogram were asked to point to the images during bladder filling. Correlation of percent of expected capacity (PEC) and image was analyzed using a linear mixed effects model. ResultsAim 1. 91 adults and 267 children (mean age 7.2 years) were surveyed. Correlation between the descriptors and images was 0.87 (95% CI 0.84-0.89) for all subjects, 0.84 (95% CI 0.81-0.88) for patients younger than 6 years, and 0.88 (95% CI 0.85-0.90) for patients aged 6 to 17 years. The sequence of the images was appropriate for increasing degree of urgency. Aim 2. 73 children were evaluated. Correlation between image and PEC was 0.75 (95% CI 0.67-0.81, p<0.001). ConclusionsFigures in the pictorial urgency scale correlate with both standard verbal descriptors and bladder volume. The pictorial scale could be a supplemental tool to improve communication of urgency sensation in younger children.