Bladder Capacity In Children Research Articles

Reduced bladder capacity without daytime voiding symptoms with nocturnal enuresis.

This study aimed to evaluate the prevalence of monosymotomatic nocturnal enuresis (MSNE) with reduced bladder capacity in children with primary nocturnal enuresis (NE) and to suggest treatment outcomes. This study retrospectively evaluated 54 children (30 males, 24 females; median age: 8; range: 5-14) who were newly diagnosed with primary NE from November 2017 to October 2019. Reduced bladder capacity in MSNE was defined when a patient's maximal voided volume (MVV) from his or her voiding diary was 75% or less than estimated functional bladder capacity ([age + 1] x 30 mL) for his or her age and there were no daytime lower urinary tract symptoms (LUTS) as assessed using history taking and questionnaires. Nineteen (35.2%) of 54 children with newly diagnosed primary NE did not report daytime LUTS. Fifteen children (27.8%) had a reduced bladder capacity and were prescribed anticholinergic or beta-3 agonist. After three months of medication, MVV significantly increased from 117.5 mL to 183.3 mL (P = 0.010), but frequency showed no significant change from 5.7 to 4.9 times a day. Improvement in enuresis occurred completely and partially in 41.7% and 25% of participants, respectively. The prevalence of reduced bladder capacity without daytime voiding symptoms was relatively high as 27.8% in children newly diagnosed with primary NE. In primary MSNE, reduced bladder capacity should be investigated using a frequency-volume chart in addition to thorough history taking or questionnaires. Anticholinergics or beta-3 agonists for MSNE with reduced bladder capacity are effective at increasing the bladder capacity of these patients.

Evaluation of Functional Bladder Capacity in Children with Nocturnal Enuresis According to Type and Treatment Outcome.

PurposeThis study aimed to identify whether functional bladder capacity (FBC) differs among subgroups of nocturnal enuresis (NE) patients and can be used to predict treatment response.MethodsA total of 69 children with NE were included in this study between July 2017 and February 2019 according to medical chart review, retrospectively. All patients completed a questionnaire about voiding symptoms and 48-hour frequency/volume (48-h F/V) charts. FBC was obtained from the 48-h F/V charts and uroflowmetry (UFM) with post-void residual volume (PVR). All patients were primarily treated with standard urotherapy and pharmacological therapy. The response rate was analyzed at 3 months after treatment.ResultsThe mean age of the 69 patients (42 male, 27 female) was 83.3 ± 22.4 months (range, 5–13 years) at the first visit. The percentages of children with monosymptomatic NE (MNE) and non-monosymptomatic NE (NMNE) on the questionnaire were 40.6% (28/69) and 59.4% (41/69), respectively. FBC of all patients was lower than the normal range of expected bladder capacity, and there were no significant differences between measurement methods, NE types (MNE vs NMNE), or response rates (p > 0.05).ConclusionChildren with NE had diminished FBC in both 48-h F/V charts and UFM with PVR. We found no difference in FBC by NE type or treatment outcome. Therefore, FBC cannot be used to distinguish between NE types or predict treatment responses.

Evaluation of bladder capacity in children with nocturnal enuresis: comparison of 48-hour frequency-volume charts and uroflowmetry measurements

Evaluation of bladder capacity in children with nocturnal enuresis: comparison of 48-hour frequency-volume charts and uroflowmetry measurements

Evidence of reduced bladder capacity during nighttime in children with monosymptomatic nocturnal enuresis

Bladder capacity in children with nocturnal enuresis is assessed by maximal voided volumes (MVV) obtained through daytime frequency volume (FV) charts. Although a degree of association has been demonstrated, daytime MVV does not consistently correspond with the nocturnal bladder capacity (NBC) in monosymptomatic nocturnal enuresis (MNE). It was hypothesized that isolated reduced NBC is a common phenomenon in children with nocturnal enuresis, despite normal daytime bladder function. The aim of this study was to evaluate NBC in children with MNE and normal daytime voided volumes. Specifically, it aimed to determine the prevalence and degree of reduced NBC when using nocturnal urine production (NUP) during wet nights as a surrogate estimate of NBC. Furthermore, it aimed to investigate the relationship between NBC and desmopressin response. Data from 103 children aged 5-15 years consecutively treated for MNE in a tertiary referral centre and with normal MVV on daytime FV charts were collected for this cohort study. Home recordings were completed for 2weeks at baseline and during desmopressin dose titration. Estimated nocturnal bladder capacity (eNBC) was assessed separately each night as the total NUP causing a wet night. If NUP during a wet night was less than MVV, it was considered to be reduced eNBC during that particular night. Surprisingly, 82% (n=84) of the children with MNE and normal daytime MVV experienced at least one wet night, with NUP below the daytime MVV indicative of a reduced eNBC. For 84 patients, mean percentage of wet nights with reduced eNBC (NUP below MVV) was 49% (SD±31). A total of 11% of children with frequently reduced eNBC (>40% of wet nights with reduced eNBC) responded to desmopressin (Summary Fig.). Of the children with frequently reduced NBC, 91% experienced wet nights, with NUP <65% of expected bladder capacity (EBC). A significant proportion of children with MNE and normal MVV during the daytime frequently experienced wet nights, with a NUP well below their MVV and even <65% of EBC. This indicated that bladder reservoir dysfunction during sleep is relatively common in MNE. This abnormality was not reflected on daytime recordings, and thus nighttime data with NUP must be collected. This phenomenon may explain treatment failure to desmopressin, despite adequate antidiuretic response.

Evaluation of bladder capacity in children with lower urinary tract symptoms: Comparison of 48-hour frequency/volume charts and uroflowmetry measurements

Objective evaluation of bladder capacity (BC) in children with lower urinary tract symptoms (LUTS) is important for recognizing types of bladder dysfunction. Bladder capacity is evaluated from 48-hour frequency/volume (48-h F/V) charts or by uroflowmetry with ultrasound post-void assessment. There are limited data on the reliability of both methods of assessment in children. The aim of the study was to compare two modalities of assessment, (F/V chart and uroflowmetry) in cohorts of children with bladder dysfunctions. Maximum bladder capacity (MBC) obtained from 48-h F/V charts was compared with volumes calculated from uroflowmetry in a cohort of 86 children with different bladder dysfunctions. The BC obtained by the two modalities was compared for the three most frequent subtypes of bladder dysfunction: monosymptomatic nocturnal enuresis (MNE), overactive bladder (OAB), and dysfunctional voiding (DV). Considering a 48-h F/V chart as standard, the sensitivity, specificity, negative and positive predictive values of uroflowmetry measurements were calculated for detecting low bladder capacity. The mean maximal bladder capacity (188±99.42ml) obtained from home 48-h F/V chart measurement was 17ml lower than the mean value obtained from uroflowmetry (205±112.11ml) (P=0.58). The differences between bladder capacities estimated by 48-h F/V chart and uroflowmetry for subjects were not significant (Figure). Concordance between 48-h F/V chart and uroflowmetry categorization of BC was present in 64 (74%) subjects. The sensitivity and specificity of uroflowmetry, in comparison with 48-h F/V chart evaluation, for recognizing low bladder capacity were 75.5% and 73.17%. The sensitivity and specificity for the different types of LUTS achieved 68.42% and 58.83% for OAB, 80% and 83% for MNE, and 50% and 83.3% for DV. According to the International Children's Continence Society, the management of MNE in children can be made without uroflowmetry. History and MBC evaluation by 48-h F/V charts yields sufficient information. Nevertheless, in situations where F/V charts are unreliable or unavailable, uroflowmetry can be used as an alternative method. The highest discrepancy between both methods of BC evaluation was found in DV; this was mainly due to the mean PVR of 31ml. For children with MNE, both 48-hour frequency/volume charts and triplicate urine flow measurement with PVR evaluation are reliable methods of maximum bladder capacity evaluation. For children with OAB or DV, both methods may be necessary for accurate evaluation of decreased BC, as F/V chart and uroflow results may not be comparable.

WITHDRAWN: The lowest acceptable bladder capacity for interpretation of uroflowmetry tests in children

Summary Introduction Under- or overdistended bladder is associated with impaired bladder emptying. Therefore, uroflowmerty of low bladder capacity is regarded as irrelevant for interpretation. However, is no general consensus with regard to the lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry in children. Objective The objective was to determine the age-specific lowest acceptable value of bladder capacity in children. Study design From September 2008 to July 2012, healthy children aged 4–9 years were enrolled for analysis. An uroflowmeter was placed in the toilets at each kindergarten or elementary school. All post-void residual urine (PVRs) was assessed within 5 minutes after voiding by suprapubic ultrasound, and estimated by the equation of height × width × depth × 0.52 mL. All children were asked to have two sets of uroflowmetry and PVR tests. Two pediatric urologists reviewed the uroflow patterns and classified the uroflow patterns as bell-shaped, intermittent, tower, plateau, and staccato-shaped. We selected tests of lower bladder capacity (voided volume + PVR) from each child to analyze the optimal cut-off value for defining the LABC. Only bell-shaped curves were regarded as normal. PVR > 20 mL and Q max 10 mL, Q max Q max and high PVR, receiver operative characteristic curves (ROC) were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity for interpretation of uroflowmetry was defined at 115% expected bladder capacity (EBC, age in years × 30 + 30 mL), and LABC as the lower boundary. Linear regression was used to establish the relationship between age and LABC. Results In total, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best-fitted age-specific LABC defined by differentiating low Q max (A) and high PVR (B) is 52.08 mL + age in years × 4.78 and 85.79 mL + age in years × 7.64 mL, respectively. For simplicity, the proposed LABC- Q max (A) and LABC-PVR (B) is age in years × 5 + 50 (LABC- Q max ) and age in year × 7.5 + 85 mL (LABC-PVR), respectively. Better reproducibility of normal flow pattern, Q max and PVR in each child were observed in the uroflowmetry tests both performed below the 115% EBC and above the LABC- Q max . Therefore, we chose LABC- Q max as the preferred lowest acceptable bladder capacity for interpretation of uroflowmetry tests. Discussion The current study used a physiological approach to determine the lowest acceptable values of bladder capacity that urinary bladder can have adequate performance for normal flow pattern, good peak flow rate, and low PVR. Within the optimal bladder capacity (upper boundary as 115% expected bladder capacity and lower boundary as LABC- Q max ), the reproducibility of uroflowmetry tests is good which improved the reliability of uroflowmetry tests. Conclusions Through the large scale study for uroflowmetry tests in children, we proposed the age specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 +50 mL.

New Contralateral Vesicoureteral Reflux after Unilateral Ureteral Reimplantation: Predictive Factors and Clinical Outcomes

Although unilateral ureteral reimplantation for vesicoureteral reflux is highly successful, new contralateral reflux will develop postoperatively in some patients. We examined predictors and clinical outcomes of postoperative contralateral vesicoureteral reflux. We reviewed patients who underwent nontapered unilateral reimplantation for primary vesicoureteral reflux graded on a 3-point scale at our institution from January 1990 to December 2002, and identified those with subsequent contralateral vesicoureteral reflux. We analyzed the association of patient/procedure characteristics with incidence, and time to resolution of contralateral reflux and postoperative urinary tract infection. Multivariable models controlled for variables associated with incidence and time to resolution of contralateral reflux. A total of 395 patients (77.2% female, median age 5.3 years) underwent ureteral reimplantation for vesicoureteral reflux. Preoperative reflux was grade 1 in 2.8% of patients, grade 2 in 56.6% and grade 3 in 40.6%. Technical success was 95.4%. After reimplantation 39 patients (9.9%) had new contralateral reflux (grade 1 in 7, grade 2 in 27 and grade 3 in 5). Median followup was 51.8 months. On multivariate analysis younger age (less than 6 years, OR 3.7, p = 0.006) and low observed bladder capacity as percent of predicted bladder capacity (less than 50% of predicted capacity, OR 6.3, p = 0.02) were significant predictors of contralateral reflux. Contralateral reflux resolved in 21 of 27 patients (77.8%) on subsequent cystography at a median of 21.5 months. Two patients underwent reimplantation for persistent contralateral reflux. Four of 39 patients (10.3%) with contralateral reflux had postoperative febrile urinary tract infections at a median of 26 months, with spontaneous resolution of contralateral reflux in all. Younger patients and those with low observed vs predicted bladder capacity may be at increased risk for postoperative contralateral vesicoureteral reflux. A majority of contralateral reflux will resolve spontaneously, and the clinical course is typically benign.

492 ARE WE UNDERESTIMATING BLADDER CAPACITY IN CHILDREN LESS THAN ONE YEAR OF AGE?

You have accessJournal of UrologyPediatrics: Neuropathic Bladder/Reconstruction1 Apr 2013492 ARE WE UNDERESTIMATING BLADDER CAPACITY IN CHILDREN LESS THAN ONE YEAR OF AGE? Daniel F.G. Costa, Luke T. Lavallée, Michael Leonard, and Luis Guerra Daniel F.G. CostaDaniel F.G. Costa Ottawa, Canada More articles by this author , Luke T. LavalléeLuke T. Lavallée Ottawa, Canada More articles by this author , Michael LeonardMichael Leonard Ottawa, Canada More articles by this author , and Luis GuerraLuis Guerra Ottawa, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1884AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Estimating bladder capacity is an important component in the evaluation of many urological disorders. For estimates to be of clinical value, precise reference ranges are needed. While accepted reference ranges have been established in adults and older children, none have been validated in infants. Kaefer et al proposed the formula [2* age (years) + 2] for children less than 2 years of age which gives an estimation of bladder capacity in ounces. This implies an average bladder capacity of 60 to 120ml for children from birth to 12 months of age. Our anecdotal experience suggests this range is frequently an over-estimate. We endeavor to determine the normal bladder capacity of children less than 1 year of age. METHODS We retrospectively reviewed the charts of children aged 0-12 months with cutaneous stigmata of spinal dysraphism who were referred to the urology clinic at the Children's Hospital of Eastern Ontario to rule out occult spina bifida between October 2004 and July 2011. Patients with normal urologic assessment, defined as those not undergoing surgery for release of tethered cord, normal ultrasound of the abdomen and pelvis, and normal urodynamic testing, were included in the study cohort. Urodynamic studies were performed by a dedicated urodynamics nurse using the Laborie Medical Technologies UDS-600. Bladder filling occurred via a catheter at a rate of 10% of the expected total bladder capacity/min Bladder capacity was defined as the volume of filling when the child voided around the catheter. We analyzed age at urodynamics, bladder capacity, detrusor pressure at capacity, bladder compliance and length of follow up. RESULTS Forty-six percent (84/183) of patients had a normal urologic assessments and met the study inclusion criteria. The average age of our patients was 8.2 months (SD = 3.1). The average bladder capacity was 46.8 ml (SD = 30.6) and the mean detrusor pressure at capacity was 9.0 cmH2O (SD = 11.1). Mean compliance was calculated to be 14.0 ml/cmH2O (SD = 13.8). The average length of follow up for our study was 41.5 months (SD = 26.9) and during this interval no patients underwent surgery for tethered cord release CONCLUSIONS Bladder capacity in infants with a mean age of 8.2 months was found to be 46.8 ml. This is less than half of the volume predicted by a commonly employed formula. A novel method of estimating bladder capacity in infants is required. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e202 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel F.G. Costa Ottawa, Canada More articles by this author Luke T. Lavallée Ottawa, Canada More articles by this author Michael Leonard Ottawa, Canada More articles by this author Luis Guerra Ottawa, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Uroflowmetry Nomograms for Healthy Children 5 to 15 Years Old

We determined flow rates and generated flow rate-voided volume nomograms based on healthy children 5 to 15 years old voiding spontaneously in their natural environment. A total of 824 healthy school children of both genders were enrolled. A single uroflow record from each child was evaluated. A total of 103 children with a voided volume of less than 50 ml and/or a staccato/interrupted uroflow pattern were excluded, and 721 records were analyzed. Data were evaluated using several mathematical formulas and goodness of fit was determined. Linear regression analysis was used to generate nomograms. Flow rates and voided volumes increased with increasing age, with the effect being more pronounced in girls. No significant difference was noted in uroflow rates from 5 to 10 years, but significant differences (p <0.001) started appearing at 11 to 15 years. Also no significant difference was noted in uroflow rates among children 11 to 15 years. Therefore, 2 age groups were designated, with group 1 consisting of patients 5 to 10 years old and group 2 consisting of patients 11 to 15 years old. There were 222 boys and 122 girls in group 1 and 240 boys and 137 girls in group 2. In group 1 the maximum and average ± SD flow rates were 15.26 ± 4.54 ml per second and 7.68 ± 3.26 ml per second, respectively, for boys and 17.98 ± 6.06 ml per second and 9.19 ± 4.23 ml per second, respectively, for girls. In group 2 these rates were 22.50 ± 7.24 ml per second and 10.78 ± 4.03 ml per second, respectively, for boys and 27.16 ± 9.37 ml per second and 13.48 ± 5.21 ml per second, respectively, for girls. This large study, which expands the scant existing literature on uroflow parameters in healthy children, will hopefully promote wider application of uroflowmetry testing in the pediatric population.

589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis1 Apr 2012589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN Ma. Fluorence Flores and David Bolong Ma. Fluorence FloresMa. Fluorence Flores Manila, Philippines More articles by this author and David BolongDavid Bolong Manila, Philippines More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.666AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uroflowmetry and post void residual studies are considered fundamental, noninvasive diagnostic tools in Pediatric Urology. Parameters are frequently used in the evaluation and reassessment of children with lower urinary tract dysfunction. Often the therapeutic decisions are based on a single or on a few determinations.Therefore, it is crucial to know whether these tests are reproducible to a clinically acceptable degree. Since current nomograms have been constructed from 1 to 2 voids per child, variability of flow parameters is unknown. This leads us to the question of “How many times should uroflowmetry and post void residual urine measurements be done to a single patient in order to get a reliable and consistent result?” In this study, we set the prevoid volume at 50 to 100% of the estimated bladder capacity of each child. OBJECTIVE To assess the repeatability and consistency of uroflowmetry and post void residual urine (PVR) determination in children at a bladder volume of 50-100% of the estimated bladder capacity (EBC). METHODS From April 2011- September 2011, twenty-five (25) children, ages 3-8 years, underwent uroflowmetry and post void urine measurements. Values were taken for 3 consecutive micturitions at a bladder volume of 50-100% of the estimated bladder capacity, as measured by transabdominal ultrasound. A total of 75 micturitions were studied. Uroflowmetry parameters and PVR were recorded and analyzed. RESULTS There were no significant differences in the measurements across three trials for maximum flow rate (Qmax) and prevoid urine volume. There were significant differences in the measurements of PVR and uroflowmetry curves. PVR urine volumes were not related to prevoid urine volumes. Age, height and weight were related to the prevoid volumes. CONCLUSIONS Uroflowmetry and post void residual tests will give informative and reliable values at a bladder volume of 50-100% estimated bladder capacity. In cases of any abnormal flow curve or pattern at this bladder capacity, a repeat examination is prudent; despite normal maximum flow rate (Qmax) and negligible post void residual urine. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e240 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ma. Fluorence Flores Manila, Philippines More articles by this author David Bolong Manila, Philippines More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Repeated botulinum‐a toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele

To evaluate the efficacy of intradetrusor injection of Botulinum-A toxin (BoNT/A) in children with neuropathic bladder dysfunction and poor bladder compliance, due to meningomyelocele. We retrospectively reviewed the charts of 11 children (mean age 6.7 ± 5.3 years) with neuropathic bladder and poor bladder compliance (mean 7 ml/cmH(2) O) treated with intradetrusor injection of BoNT/A. After urodynamic evaluation a standardized injection was performed. The authors describe their results in 11 children after the first (5×) or repeated (6×) BoNT/A injections. Re-evaluation was performed 3 and 12 months after each injection. Three months after injection detrusor pressure decreased by 17% and bladder capacity increased by 33%. In all but 1 patient bladder compliance stayed poor. Twelve months after treatment patients still had an effect but the values were already reverting towards preoperative levels. With repeated injections we achieved a similar effect on capacity and detrusor pressure as after the first injection. Overall, bladder compliance normalized (>20 cmH(2) O) in only 1 patient. The results confirmed the positive temporary effect of BoNT/A on detrusor pressure and bladder capacity in children with myelomeningocele, even after repeated injections. Nevertheless, bladder compliance stayed severely pathological. Whether an earlier treatment may prevent poor bladder compliance is a yet unanswered question.

Effect of Rectal Distention on Lower Urinary Tract Function in Children

We investigated the effect of rectal distention on lower urinary tract function. Children were assigned to a constipation and lower urinary tract symptoms group or to a lower urinary tract symptoms only group. The definition of constipation was based on pediatric Rome III criteria. Standard urodynamics were done initially and repeated during simultaneous barostat pressure controlled rectal balloon distention and after balloon deflation. We evaluated the effects of rectal balloon inflation and deflation on urodynamic parameters. Colonic transit time measurement, anorectal manometry and the Parenting Rating Scale of child behavior were also used. We studied 7 boys and 13 girls with a median age of 7.5 years who had constipation and lower urinary tract symptoms, and 3 boys and 3 girls with a median age of 7.5 years who had lower urinary tract symptoms only. Urodynamic patterns of response to rectal distention were inhibitory in 6 children and stimulatory in 12, and did not change in 8. In 54% of the cases balloon deflation reversed balloon inflation changes while in 46% balloon inflation changes persisted or progressed. No significant differences were noted in children with vs without constipation and no clinical symptom or diagnostic study predicted the occurrence, direction or degree of bladder responses. In almost 70% of children with lower urinary tract symptoms rectal distention significantly but unpredictably affected bladder capacity, sensation and overactivity regardless of whether the children had constipation, and independent of clinical features and baseline urodynamic findings. Urodynamics and management protocols for lower urinary tract symptoms that fail to recognize the effects of rectal distention may lead to unpredictable outcomes.

Which method is the most reliable in determination of bladder capacity in children with idiopathic overactive bladder? A comparison of maximum voided volume, uroflowmetry and maximum cystometric capacity

To compare uroflowmetry, maximum cystometric capacity and maximum voided volume in terms of bladder capacity (BC) estimation in children with idiopathic overactive bladder. A total of 84 children with idiopathic overactive bladder were enrolled. Bladder diaries were kept by parents to measure maximum voided volume. The sum of voided volume and post-void residual urine represented uroflowmetric BC. Maximum cystometric capacity was recorded for each patient. Patients with and without urge incontinence and both sexes were compared, and correlations were tested between estimated capacities, patient age and continence status. Mean age was 10.88 (range 6-16) years. There were 52 females and 32 males. A total of 48 patients had urge incontinence (group 1), and the remaining 36 (group 2) did not. Mean bladder capacities were 165.44ml for uroflowmetry, 204.37ml for cystometry and 260.07ml for bladder diary. Maximum cystometric capacity and capacity in terms of maximum voided volume by diary were significantly higher in patients without urge incontinence. There were significant correlations between age and all other variables, and between the presence of urge incontinence and all variables except maximum cystometric capacity. There were significant differences between bladder capacities estimated by the three methods; however, on age-adjusted re-analysis this significance was lost. There is no significant difference between BCs estimated by uroflowmetry, maximum cystometric capacity and maximum voided volume in children with idiopathic overactive bladder. Bladder diary is a reliable and non-invasive way of estimating BC in this patient population.

The Relevance of Urodynamic Studies for Urge Syndrome and Dysfunctional Voiding: A Multicenter Controlled Trial in Children

The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment. In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome. Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

POS-02.104: Sleep stage and functional bladder capacity in children with refractory nocturnal enuresis

POS-02.104: Sleep stage and functional bladder capacity in children with refractory nocturnal enuresis

Reference Ranges for Cystographic Bladder Capacity in Children—With Special Attention to Vesicoureteral Reflux

Linear correlations for cystometric/cystographic bladder capacity with age universally serve as clinical yardsticks in pediatric urology and nephrology. However, these correlations do not account for growth or the range in values, as the relation of cystometric/cystographic bladder capacity with age is nonlinear. Also, vesicoureteral reflux might influence the size of cystometric/cystographic bladder capacity, since small and large bladder capacities have been reported in conjunction with reflux. We decided to use the data sets of the International Reflux Study in Children to construct full reference ranges for cystometric/cystographic bladder capacity and age, for comparison with existing reference ranges in normal children, and to study the relation between bladder capacity and refluxing volume. In the International Reflux Study in Children 386 patients with grade III or IV vesicoureteral reflux were followed with isotope cystography for 10 years. To follow the grade of reflux, x-ray cystography was also used at 60-month intervals. The 386 children, who were 1 month to 12 years old, were randomized into 2 groups-those undergoing surgery and those receiving medical treatment. For both groups data were available on cystometric/cystographic bladder capacity, refluxing volume, reflux grade and reflux outcome. The distribution of cystometric/cystographic bladder capacity vs age is logarithmic, with a wide range between the 5th and 95th percentiles, and a clear nonlinear relation between bladder capacity and age (p < 0.001). Gender has no influence on cystometric/cystographic bladder capacity. No difference in bladder capacity exists between persistence or resolution of vesicoureteral reflux (p < 0.78), between grade III and grade IV reflux (p < 0.94), or between unilateral and bilateral reflux (p < 0.74). Thus, refluxing volume correlated only with reflux grade, not with cystometric/cystographic bladder capacity or age. With or without vesicoureteral reflux values for cystometric/cystographic bladder capacity range widely in children, and correlate logarithmically with age. For clinical decisions the full reference range for age, flanked by the 5th and 95th percentiles, should be used to assess individual values for cystometric/cystographic bladder capacity, rather than linear functions.

The Role of Bladder Capacity in Antidiuretic and Anticholinergic Treatment for Nocturnal Enuresis

We evaluated combination treatment with desmopressin and oxybutynin in patients with enuresis who did not respond to desmopressin monotherapy. Furthermore, we compared 2 methods of estimating bladder capacity and evaluated the ability of these methods to predict the response to desmopressin and oxybutynin. A total of 60 children with a mean age +/- SD of 10.6 +/- 3.0 years who had monosymptomatic nocturnal enuresis completed the study. After a 2-week observation period maximal voided volume during free access to fluid intake was determined by a 2-day frequency-volume chart and maximal voided volume after water load was determined on a separate day. Patients then received 20 mug desmopressin intranasally at bedtime during 2 weeks. In nonresponders to desmopressin with less than a 50% decrease in wet nights 5 mg oxybutynin twice daily was added for another 2 weeks. Of the patients 41 (68%) showed more than 50% decrease in wet nights during the 2-week desmopressin treatment period (4.6 +/- 1.6 to 0.7 +/- 0.8, p <0.001). In desmopressin nonresponders combined treatment with desmopressin and oxybutynin resulted in a further decrease in wet nights (4.0 +/- 1.2 to 1.7 +/- 1.4, p <0.001). Maximal voided volume during free access to fluid intake was significantly higher in desmopressin responders than in nonresponders (244 +/- 111 vs 160 +/- 65 ml, p <0.001). In contrast, maximal voided volume after water load was not significantly different between desmopressin responders and nonresponders. The study indicates a role for oxybutynin in combination with desmopressin in children who are not responding to desmopressin monotherapy. Maximal voided volume during free access to fluid intake is a clinically useful predictor of the response to desmopressin but not to oxybutynin.

Bladder Reservoir Function in Children With Monosymptomatic Nocturnal Enuresis and Healthy Controls

We investigated bladder reservoir function in children with monosymptomatic nocturnal enuresis and in healthy controls. A total of 18 children with monosymptomatic nocturnal enuresis and 119 controls who were 7 to 13 years old were recruited. Children completed frequency volume charts and measurements of nocturnal urine production. Mean diuresis in the period preceding each voiding was calculated. Those with enuresis were grouped according to bladder capacity and hospitalized for 4 nights, including a baseline night and 3 with an oral water load. Enuresis volumes and post-void residual volume were estimated, allowing the calculation of bladder volume at the time of enuresis. Nine children with monosymptomatic nocturnal enuresis were characterized as having normal bladder capacity and 9 had decreased bladder capacity. We found large intra-individual variability in daytime voided volume in all 3 groups of participants. Children with enuresis and small bladder capacity generally voided with volumes close to maximal voided volume. A total of 93 enuresis episodes were recorded. Large intra-individual variability was seen in bladder volume at enuresis and it was lower than maximal voided volume in more than 50% of episodes. Variability in bladder volume at enuresis was greatest in the patient group with decreased bladder capacity. We found a significant correlation between diuresis and bladder capacity in all groups during the day and night. There is a great intra-individual diurnal variability in voided volume in children with enuresis and in healthy children. Enuresis seems to occur at bladder volumes that are smaller and larger than the maximal voided volume obtained from voiding charts.

Transverse Myelitis in Children: Long-Term Urological Outcomes

Urological complications are well documented in patients with traumatic spinal cord injury. We examined the long-term urological outcomes in a large population of children affected by transverse myelitis. We retrospectively reviewed the medical history, imaging studies and urodynamic findings in 22 children with transverse myelitis. Age at disease onset ranged from 3 months to 18 years (average 8.8 years). At a mean followup of 7.1 years 19 patients (86%) had persistent bladder dysfunction and 17 (77%) had persistent bowel dysfunction. Initial evaluation at least 1 month after disease onset revealed detrusor overactivity in 59% of patients, detrusor external sphincter dyssynergia in 41%, low compliance in 47% and detrusor leak point pressure greater than 40 cm water in 12%. Functional motor recovery and absence of lower extremity spasticity did not reflect normal urodynamic findings. Of the 19 patients with imaging available for review 5 (26%) had upper tract changes. One patient had development of chronic renal insufficiency. Low compliance (p = 0.02) and upper tract changes (p = 0.1) were more frequent in patients who started clean intermittent catheterization more than 2 years after disease onset. Persistent bowel and bladder dysfunction is common in transverse myelitis. Urodynamic abnormalities may be present despite normal neurological examination and absence of urinary symptoms. All pediatric patients with transverse myelitis require baseline renal ultrasound and urodynamic evaluation to guide treatment. Early institution of clean intermittent catheterization appears to preserve bladder compliance and decrease upper tract disease, and should be instituted at disease onset.

The Impact of Late Presentation of Posterior Urethral Valves on Bladder and Renal Function

We retrospectively reviewed the records of patients with late presentation of PUVs, and compared bladder and renal function to that in patients with an early diagnosis of PUVs. We retrospectively reviewed the charts of 36 males (mean age at diagnosis 8.8 years, range 5 to 14) with late presentation of PUVs who were treated at our institution between 1986 and 2004. Of these patients 20 had undergone urodynamic evaluation during followup (mean age 10.65 years, range 5 to 23). We chose as controls 19 age matched children with PUVs who were diagnosed and treated before age 5 years and underwent urodynamic evaluation during followup (mean age at urodynamic evaluation 8.52 years, range 6 to 15). Urodynamic parameters were compared between the 2 patient groups. Renal function in the late presenting cases was also compared to controls. The most common symptoms at presentation were diurnal enuresis (17 patients, 47.2%) poor stream (7, 19.4%) and urinary retention (5, 13.9%). Overall, urodynamic bladder abnormalities were detected in 17 of 20 patients (85%), detrusor overactivity in 3 (15%), significant post-void residual in 9 (45%) and bladder capacity greater than expected for age in 9 (45%). No significant difference in bladder capacity, compliance or post-void residual was demonstrated between the late presenting and control groups. Only detrusor overactivity was significantly lower in the late presenting group (p = 0.013). After a mean followup of 67.03 months age specific creatinine levels were increased in 13 of 27 patients (48.1%), including 7 (25.9%) with ESRD. Renal function was significantly impaired in the late presenting group compared to controls (48.1% vs 13.7%, p = 0.001). We found a significantly lower rate of detrusor overactivity (15%) in patients with late presenting PUVs. Comparison of urodynamic parameters between the early and late presenting groups did not reveal any significant difference. This similar pattern of bladder dysfunction, independent of age at relief of obstruction, may indicate a common pathophysiological etiology for bladder dysfunction in all patients with PUVs. Also, renal function was significantly impaired in the late presenting group in this series.