Noninvasive Urodynamic Studies Research Articles

MP08-20 THE COMPARISON OF ANXIETY LEVELS IN CHILDREN WHO UNDERWENT INVASIVE OR NON-INVASIVE URODYNAMIC STUDIES

You have accessJournal of UrologyCME1 May 2022MP08-20 THE COMPARISON OF ANXIETY LEVELS IN CHILDREN WHO UNDERWENT INVASIVE OR NON-INVASIVE URODYNAMIC STUDIES Cagri Akin Sekerci, Onur Can Ozkan, Yiloren Tanidir, Tufan Tarcan, and Selcuk Yucel Cagri Akin SekerciCagri Akin Sekerci More articles by this author , Onur Can OzkanOnur Can Ozkan More articles by this author , Yiloren TanidirYiloren Tanidir More articles by this author , Tufan TarcanTufan Tarcan More articles by this author , and Selcuk YucelSelcuk Yucel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urodynamic studies play an important role in the evaluation of children with lower urinary tract dysfunction. In this study, we aimed to examine the effects of invasive and non-invasive urodynamic studies on the anxiety levels of children with the help of an anxiety scale. METHODS: Children aged 8-17 years who were scheduled for uroflowmetry (UF) or filling cystometry (FC) and who agreed to fill out an anxiety scale were included in the study. It was the first UF or FC of all children. “The Screen for Child Anxiety Related Disorders (SCARED)” form consisting of 41 questions was used in the evaluation. All children included in the study filled the form themselves. The SCARED results of children who underwent UF and FC were compared. RESULTS: A total of 56 children with a mean age of 10.85+/-2.98 years were included in the study. 31 (55.4%) of the children were females and 25 (44.6%) were males. The number of children who had UF was 26 (46.4%; 8.5 (8-14) years), and 30 (53.6%; 11.5 (8-17) years) had FC. The total SCARED scores of the children who underwent UF and FC were 26.5 (5-75) and 27 (2-57), respectively, and there was no statistical difference (p=0.980) (Table 1). A significant difference was found only in "Separation Anxiety Disorder" among sub-score evaluations (p=0.049) (Table 1). In children who underwent filling cystometry, there was no statistical difference in the total SCARED score between those who did and did not do clean intermittent catheterization (28 (3-41); 27 (2-57), respectively) (p=0.860). CONCLUSIONS: The SCARED scores above 25 indicate an anxiety disorder, and interestingly, in this study, both the invasive and noninvasive urodynamic study groups scored over 25. We consider that non-invasive urodynamic tests may cause stress on children as much as invasive ones. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e134 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cagri Akin Sekerci More articles by this author Onur Can Ozkan More articles by this author Yiloren Tanidir More articles by this author Tufan Tarcan More articles by this author Selcuk Yucel More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0643 - The comparasion of anxiety levels in children who underwent invasive or non-invasive urodynamic studies

A0643 - The comparasion of anxiety levels in children who underwent invasive or non-invasive urodynamic studies

Check cystoscopy in the management of anterior urethral valves in a cohort of pediatric patients

Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient's age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available. We describe our protocol for AUV treatment based on primary endoscopic valve ablation followed by check cystoscopy 15 days later. Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and VCUG were performed in all children, while urodynamic evaluation was performed in the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves ablation and after 15 days after a second look cystoscopy was performed. Follow up was based on clinical and radiological evaluation with US, urinalysis and blood tests. Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained patients and VCUG was performed in 1/5 patient. and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra in another case. In 3/5 patients check cystoscopy found residual valves and a second endoscopic ablation was performed. All patients achieved symptoms release and improved urodynamic parameters. No intra or post-operative complication were reported. The assessment of residual valves is variable in literature and it is usually described for posterior urethral valves (PUVs). Few series report the use of VCUG within the first week after valve ablation, our experience instead suggests that performing a second look cystoscopy, is very effective to evaluate the presence of residual AUVs and eventually proceed with further ablation. Endoscopic ablation is the gold standard treatment for AUV, but residual valves management is not clearly defined. According to our experience, a check cystoscopy 15 days after primary ablation allows to identify and treat possible residual valves showing good results in terms of safety and efficacy.

Ultrasonographic cystometry for neurogenic bladder using elastography.

Ultrasound shear wave elastography (SWE) has been used to measure elasticity (Young's modulus: YM) in solid organs. It was reported to show a better correlation with intravesical pressure (Pves) than with compliance, supporting its potential use in noninvasive cystometry. Contrariwise, conceptually, YM should be more correlated with compliance than with Pves. To optimize the potential use of YM as a noninvasive urodynamic study, the relationship between YM, Pves, and compliance was reassessed in this study. YM was serially measured using SWE along with bladder filling. To overcome problems inherent to current compliance measurements, modified dynamic compliance was developed from cystometry by a locally weighted scatter plot smoothing algorithm. Then it was matched with YM from SWE. YM was also correlated with Pves. Furthermore, to understand the nature of YM, which was measured by ultrasound, the bladder wall's modulus, which was the mathematical assessment of YM derived from cystometric data, was also calculated and compared. Thirty-two neurogenic bladder patients were included in this study. YM correlated with Pves (r = .72, p < .0001) better than with modified dynamic compliance (r = -0.43, p < .0001). The correlation of YM with Pves was even higher than that with the calculated bladder wall's modulus (r = .52, p < .0001). YM measured by SWE associates with Pves better than with compliance, confirming the results of previous studies. SWE reflects the integration of both the holding capability of the bladder wall and urine rather than either of one, implying its potential utilization in noninvasive cystometry.

IJU this issue

Yukio Homma md phdAssociate Editor One of the latest advances in urological oncology is the introduction of molecular targeted therapy for renal cancer. The discovery of genetic events and specific molecules in renal carcinogenesis has made the therapy plausible. However, accumulating clinical experiences have raised numerous questions, which are commented on by four experts in the editorial of this issue. The common views are: (i) targeted therapy is a clinical advance but not a universal remedy; (ii) cytokine therapy, which has been the mainstay for decades, is still an active option; (iii) combined or sequential use of available therapies would provide more favorable responses; (iv) prophylactic use to prevent development of phenotypes in hereditary renal cancer is premature; (v) better survival in Japanese patients on cytokine therapy, confounded by clinical practice, cannot be simply translated into a difference of efficacy; (vi) research on new targets and predictive markers is warranted for therapy individualization; and (vii) urologists should remain the principal players in research and clinical coordination of multiple treatments. As for other topics on renal cancer, Elsamra et al. (Rhode Island, USA) found 1–6% major complication rates in their review article on laparoscopic surgery. A uniform manner in reporting complications is strongly encouraged to facilitate comparison. An extensive review on thermal ablation therapy for small renal tumor was made by Kimura et al. (Sagamihara, Japan). Ablation therapy is to be indicated more often considering its low invasiveness and comparative oncological outcomes. Molecular targeted therapy is also applicable to castration-resistant prostate cancer, one of the hardest challenges to us. Sonpavde (Rome, Italy) reviewed the clinical efficacy of docetaxel and suggested it as the combination partner. Geldanamycin, a heat shock protein inhibitor, might be an alternative to augment androgen-responsiveness, as demonstrated by Suzuki et al. (Tokyo, Japan), in prostate cancer cell lines under hypoxic conditions. In localized prostate cancer, the clinical concern is existence of significant cancer and prediction of extra-capsular extension. A nomogram presented by Ohigashi et al. (Tokyo, Japan) predicts the existence of significant cancer before biopsy in men with serum prostate-specific antigen (PSA) less than 10 ng/mL using digital rectal examination and PSA parameters as the predictors. Sataka et al. (Tokyo, Japan) estimated probability of extra-capsular extension with laterality by the maximum percentage of cancer in the biopsy sample alone or in combination with other common predictors. The limitations of these nomogram studies, such as relatively small sample size and uncertainty in daily clinical decision-making, are mentioned in editorial comments by Tanaka (Nara, Japan) and Yamamoto (Tokyo, Japan). Unlike prostate cancer, urothelial cancer does not have good tumor markers, even in advanced stages. Okegawa et al. (Mitaka, Japan) detected circulating cancer cells in 11 of 20 cancer patients with metastases but none of 16 without metastases. Detection by the CellSearch system can work as a metastatic marker in urothelial cancer. Ozawa et al. (Okayama, Japan) summarized the role of ultrasound in the assessment of lower urinary tract function in their review article. They provided further details on elegant non-invasive urodynamic study using Doppler ultrasound for monitoring the urinary flow in the urethra to calculate flow resistance. Deng et al. (Guan Zhou, China) observed outcomes of hydronephrosis drained by nephrostomy in 14 children. The parenchyma thickness increased by 7 mm in 4 weeks most likely by shrinkage of the dilated collecting system. Tubular protein returned to the baseline level in a similar range of time. Seminalysis is usually done under light microscopy. Visco et al. (Rome, Italy) found the superiority of transmission electron microscopy in detecting anomalies in tail and midpiece of sperms. Head defects and excess residual cytoplasm were equally identified by light microscopy.

Epidemiological Aspects of Recruitment of Male Volunteers for Non-Invasive Urodynamics

Introduction: We studied epidemiological aspects of recruitment of volunteers for a non-invasive urodynamic study. Materials and Methods: 9,236 volunteers were invited by 20 general practitioners (GPs), using two different recruitment methods, i.e. by mail only, or during a subsequent visit to the GP’s office. Factors influencing the response rates were analyzed. We also tested how much the recruited population of volunteers differed from the general population, by comparing it to another, proven representative study carried out earlier in 1,662 subjects. Results: In the recruited population the prostate volumes were not significantly different from the proven representative study, but the symptom score was statistically significantly higher, although the difference was so small it may be called clinically irrelevant. Recruitment of volunteers in two steps, i.e. asking them first to visit the GP’s office, and inviting them there to visit the outpatient clinic, rather than directly inviting them (in writing) to the clinic seemed to lead to a higher response, although this effect could not be statistically discriminated from the difference in response rates between GPs. Conclusion: The population recruited was not urologically different from the general population. The response depended on age, being highest around the age of 60, and increased with social economic status. It also depended on the GP who recruited the subjects, and/or on the recruitment method.

Symptom score for lower urinary tract dysfunction in pediatric urology

Lower urinary tract dysfunction is a common component of virtually every pediatric urologist's practice. Although lower urinary tract dysfunction should be considered more of a social nuisance than a true medical condition, if left unchecked, real comorbidities may occur. A thorough history, physical examination, voiding diary, and noninvasive urodynamic studies, such as flow rate or flow rate with electromyography, generally are used to make an accurate diagnosis. Once the diagnosis is established, a wide range of therapies are available and their use may be based on the age of the child, duration of symptoms, etiology of the lower urinary tract dysfunction and associated urologic disease, and physician or family preferences. Symptom scoring systems have been devised to confirm diagnosis of lower urinary tract dysfunction, classify its severity, and serve as a monitoring instrument to determine response to treatment.

Polyethylene Glycol 3350 for Constipation in Children With Dysfunctional Elimination

Children with daytime wetting often have constipation, and treatment of constipation helps children become dry. Polyethylene glycol 3350 (Miralax, Braintree Laboratories, Braintree, Massachusetts) is a nonaddictive, tasteless powder that can be mixed with any liquid for treatment of constipation. We review our use of polyethylene glycol 3350 in 35 girls and 11 boys with dysfunctional elimination. Noninvasive urodynamic studies and post-void residual measurement were performed before and during treatment. A significant increase in frequency of bowel movements occurred while taking polyethylene glycol 3350 (p = 0.0001). Average final dose was 0.63 gm/kg. The only reported adverse effect was diarrhea (9 patients). Of the children 18 became dry, 26 had decreased wetting and 2 had no improvement. Voided volume increased (146 vs 210 ml, p <0.0001) and post-void residual decreased significantly (92 vs 48 ml, p <0.0001) while on polyethylene glycol 3350. Ten children were still considered constipated including both patients who experienced no change in wetting. Average final dose in this group (0.69 gm/kg) did not differ significantly from those in whom constipation resolved (0.61 gm/kg). Patients in whom constipation resolved had a significantly lower post-void residual than those who remained constipated (11.8% vs 30.6%, p <0.01) and were significantly more likely to become dry or improved (p = 0.045). The efficacy, compliance and lack of significant side effects make polyethylene glycol 3350 an ideal substance for treatment of constipation in children with dysfunctional elimination. Persistent constipation was associated with decreased resolution of voiding symptoms and significantly increased post-void residuals.

Neurovesical dysfunction in children after treating pelvic neoplasms

To evaluate 10 years of experience, and thus define the occurrence and causes, of neurogenic lower urinary tract dysfunction in children with pelvic neoplasms treated by surgery. From 1991 to 2000, 33 children were operated by the same surgeons for pelvic neoplasms; 11 were analysed, comprising four each with sacrococcygeal teratoma (ST) and ganglioneuroma, and one each with yolk sac tumour (YST), neuroblastoma and myofibroblastic bladder sarcoma (MBS). The other patients were not assessed because eight had died or were in severe progression, three were treated by bladder substitution and the others were lost to follow-up or refused a urological evaluation. All 11 children were evaluated at >/= 6 months after surgery with a questionnaire about bowel and voiding habits, a neurological and orthopaedic assessment, a noninvasive urodynamic study, renal ultrasonography and spinal and pelvic magnetic resonance imaging (MRI). All patients with signs of bladder dysfunction were evaluated by a pressure-flow study. The results were analysed for surgical approach and anatomical involvement, i.e. group A, extensive surgery for complete tumour excision in the sacral area (ST and YST); group B, surgery for tumour resection in the paraspinal ganglia area (neuroblastoma and ganglioneuroma); and group C, bladder tumour with partial bladder resection (MBS). Eight patients had signs or symptoms related to bladder sphincter dysfunction. One child refused the invasive urodynamic evaluation, leaving seven for analysis (two each ST and ganglioneuroma, one each YST, neuroblastoma and MBS). The urodynamic findings were normal in three children. On spinal and pelvic MRI a presacral lipoma with syringomyelia was discovered in one child with ST. Eight children had bladder dysfunction and two had no neurogenic damage (which was only in sacral tumours); in one child it was related to an upper motor neurone lesion from spinal dysraphism and in the other to a lower motor neurone lesion from surgical injury to the splanchnic nerves. Patients operated for paraspinal tumours had more bladder dysfunction but no signs of neurogenic damage, as did the patient with partial bladder resection. However in Group B, there may have been a transient or incomplete nerve injury in one patient. Deficits of parasympathetic, sympathetic and somatic innervation of the bladder and the urethra may occur in children after surgery for pelvic neoplasms, related to minor or major surgical trauma. In ST, a tethered cord may be associated with mixed neurogenic damage. Knowledge of bladder dysfunction in anorectal malformations, spinal dysraphism, etc. and the clinical protocol used in these patients also seemed to be useful for understanding the development of voiding dysfunction in patients with neoplasm.

Epididymitis in Older Boys: Dysfunctional Voiding as an Etiology

Although male infants and young boys with epididymitis have a high incidence of anatomical pathology, dysfunctional voiding is not a well established cause of epididymitis. In our series 36 boys with epididymitis underwent noninvasive urodynamic studies to determine whether a physiological defect could be assigned as an etiology. The 2 mechanisms proposed are similar to that in children with vesicoureteral reflux associated with dyssynergia or bladder instability and to a cause of recurrent urinary tract infection in children (the infrequent voider syndrome). Urinalysis and urine culture are recommended in all children with epididymitis and urethral swabs are obtained from those who are sexually active. We recommend renal/bladder ultrasound and voiding cystourethrography in all infants and young children with epididymitis. In the older child we advocate detailed questioning regarding voiding symptoms and the performance of noninvasive urodynamic studies.

Evaluation of acute scrotum in the emergency department

A 2-year retrospective review of 238 cases of acute scrotal pain encountered in a children's hospital emergency department is presented. The incidences of testicular torsion, torsion of a testicular appendage, and epididymitis were 16%, 46%, and 35%, respectively. Testicular salvage was critically dependent on the interval between onset of pain and surgical intervention. No testis likely to have been viable at the time of presentation was “lost.” The diagnostic error rate on first encounter was 7%, resulting in 10 negative scrotal explorations. With the exception of cases of far-advanced necrotic testes, both color Doppler ultrasound and radioisotope imaging were highly specific diagnostic modalities. Thirty-nine percent of the children with epididymitis who underwent investigation were found to have either structural or functional urinary tract abnormalities. Noninvasive urodynamic studies appear to be useful screening modalities in older children with epididymitis.

Abdominal Wall Electromyography: A Noninvasive Technique to Improve Pediatric Urodynamic Accuracy

Abdominal wall electromyography, using sticky surface patch electrodes placed on the rectus abdominus muscles, was used during noninvasive urodynamic studies in 60 children to detect straining. Straining, which usually was imperceptible to the examiner, occurred in 64 per cent of neurologically normal children. Urodynamics identified detrusor-sphincter dyssynergia during straining to void but reverted to normal when the same children voided without straining. Because the urodynamic findings that characterize detrusor-sphincter dyssynergia are mimicked by straining and other common urologic entities, the potential for misdiagnosis is great unless some assessment of intra-abdominal pressure is made during neurourologic testing.