Urodynamic Studies In Children Research Articles

Effect of biofeedback pelvic floor training on urodynamic study in children with detrusor sphincter dyssynergia

ABSTRACT Introduction Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spina bifida. It is associated with urinary incontinence (UI), nocturnal enuresis, urgency, intermittency, and recurrent urinary tract infections (UTIs). The Aim of this Study It aims to assess the efficacy of biofeedback (BF) for achieving perineal synergy and improving symptoms in thirty children with refractory DSD who failed to improve with medical treatment in the last 2 to 3 years. Material and Methods Thirty children (20 girls and 10 boys) aged 6–18 years (mean: 9.2 ± 2.2 yrs) with refractory DSD who failed to show improvement after 2–3 years of medical treatment with recurrent UTI and failure to emptying completely their bladder using urodynamic study. After patients understood the concept of BF pelvic floor training were regularly scheduled twice weekly for up to 3 months. Improvement was assessed using interview with parents after 3 months with measurement of manomeric pelvic floor muscles (PFMs) during straining and urodynamic study. Results Seven (23.3%) of the 30 children had daytime UI and 11 (36.7%) had nighttime incontinence. 4/30 (13.3%) children had increased urgency and 5 (16.7%) had straining intermittency and 3% (10%) had Dysuria. After 3 months of BF pelvic floor training 7/30 (23.3%) of children were fully responsive 100% decrease of symptoms, 14/30 (46%) responded more than 90% decrease of their symptoms, 7/30 (23.3%) of children responded partial decrease of symptoms and 2/30 (0 to 49%) decrease of symptoms to BF pelvic floor training. Conclusions BF pelvic floor training is an effective therapeutic option for children with refectory DSD. It improves symptoms of children with DSD with decreased UTIs through decreasing pressure of PFMs during urination.

Comparison of maximum voided volume and maximum bladder capacity in voiding diary, uroflowmetry and cystometrography in children with non-neurogenic lower urinary tract dysfunction

BackgroundMaximum voided volumes (MVV) and maximum bladder capacities (MBC) are important parameters in the evaluation of lower urinary tract functions in children. However, consistency of MVV and MBC measurements between voiding diary (VD), uroflowmetry (UF) and cystometrography (CMG) in children with non-neurogenic lower urinary tract dysfunction (LUTD) has not been addressed specifically. ObjectiveWe aimed to compare the MVV in VD and UF and MBC in CMG in children with non-neurogenic LUT dysfunction and investigate for possible factors for discrepancies. Materials and MethodsChildren with non-neurogenic LUTD were retrospectively evaluated with a focus on VD, UF, and CMG. VD applied for 2 days and MVV recorded except for first urine in morning. UF repeated in children with < 50% of expected bladder capacity (EBC) for age. Highest value and post voiding residual urine (PVR) was recorded. CMG was performed if these conditions were present: High PVR or LUT dysfunction resistant to standard urotherapy (conservative management with biofeedback) and medical therapy (oral anticholinergics) or LUT dysfunction accompanied by VUR or recurrent UTI. MBC in CMG was recorded according to International Children Continence Society (ICCS) standards. MVV and MBC in VD, UF, CMG were compared and possible factors for discrepancy were investigated. Results54 children (median age: 10 (4-17) years) were included in the study. 39 (72.2%) were girls, 15 (27.8%) were boys. Median MVV was 232.50 (20-600) ml in VD, 257.50 (69-683) ml in UF and MBC was 184 (31-666) ml in CMG (p= 0.012) (Summary Table). In the subgroup analysis, it was shown that the bladder capacities obtained from all three tests were not compatible with each other in children younger than 10 years of age, in girls, in those with recurrent urinary tract infection, detrusor overactivity, high PVR and normal flow pattern (p=0.003, p=0.016, p=0.029, p<0.001, p=0.045, p=0.03, respectively). DiscussionThere is a discrepancy between bladder capacities obtained from VD, UF and CMG In children with non-neurogenic LUT dysfunction. In particular, the lower capacity obtained from invasive urodynamic tests may be related to the poor compliance of children during the procedure. Therefore, when invasive urodynamics is required in these cases, we recommend that maximum cystometric capacity to be evaluated by comparing with voided volumes at UF, VD and other clinical signs and symptoms, and urodynamic parameters in more detail. ConclusionMVV in VD and UF are comparable, but MBC in CMG is lower in children with non-neurogenic LUTD selected for invasive urodynamic studies. More attention should be paid to bladder capacity obtained from urodynamic studies in children exhibiting the characteristics identified in the subgroup analysis. We believe that evaluating bladder capacity values, especially obtained from invasive studies, in conjunction with clinical findings can prevent misdiagnosis, over investigation and overtreatment in children with non-neurogenic LUTD.

СТАНДАРТЫ ПРОВЕДЕНИЯ И ИНТЕРПРЕТАЦИИ РЕЗУЛЬТАТОВ УРОДИНАМИЧЕСКИХ ИССЛЕДОВАНИЙ У ДЕТЕЙ

Article represents a bibliographical review on the problem of standards for conducting urodynamic research methods. The need for urodynamic studies is quite high and is due to the high prevalence of urination disorders in children. At the same time, the Russia urodynamic laboratories count is low and they aren’t available in all Russia regions. Plus, the number of scientific publications on urodynamics and the pediatric neurology in general is clearly insufficient. Performance of urodynamic studies in adult patients is standardized by the ICS guidelines. At the same time not all of the guidelines are acceptable in children, it is therefore necessary to approach each clinical situation individually when choosing methods for urodynamic research. This review discusses methods of urodynamic studies, such as: uroflowmetry, uroflowmetry with simultaneous recording of pelvic floor electromyography, cystometry, pressure-flow study and urethral profilometry. A brief historical background is presented as well as the indications for the methods of urodynamic research, the research techniques and the peculiarities of the results interpretation. In addition, an example of a conclusion is shown when conducting a comprehensive urodynamic study in a pediatric patient. The article is aimed at standardizing the conduct, the interpretation of the results and the formulation of conclusions when conducting urodynamic studies in children.

Pay attention to lower urinary tract dysfunction and the clinical application of urodynamic studies in children

Lower urinary tract dysfunction (LUTD) is the dysfunction of bladder and urethra during bladder filling and voiding phase. There are two general categories: neurogenic and non-neurogenic. It can cause upper urinary tract damage if left untreated. Urodynamic study (UDS) can objectively detect the function of detrusor and sphincter of urethra as well as predict the damage of LUTD to upper urinary tract. However, the development of UDS for children in China has not been popularized, which affects the accurate diagnosis and the treatment of LUTD. This article reviewed the importance of paying attention to LUTD and promoting the clinical application of UDS in children, so as to improve the diagnosis and treatment of LUTD in children.

A 15-year retrospective review of urodynamic studies in children at Red Cross War Memorial Children’s Hospital, Cape town, South Africa

BackgroundDespite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa.MethodsA retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study.ResultsThis study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention.ConclusionsThe unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.

Overactivity index: A noninvasive and objective outcome measure in overactive bladder in children

Reports showed that observing detrusor overactivity (DO) and maximum cystometric capacity (MCC) may guide rational pharmacotherapy. Since urodynamic studies (UDS) are challenging for both patients and the healthcare system, a non-invasive objective prognostic marker is preferable. To investigate the value of the overactivity index (OI), a non-invasive measure calculated from the frequency-volume chart (FVC), for predicting the presence of symptoms and abnormal UDS in children with non-neurogenic OAB. This was a prospective interventional study on a consecutive sample of 92 children with urgency treated with anticholinergics and standard urotherapy. Data from history, physical examination, bladder diaries, kidneys and bladder ultrasonography, uroflow, urinalysis, urine culture, and UDS was collected at baseline, and after 3 and 6 months. Binary logistic regression was used to evaluate noninvasive parameters as predictors of Overactive Bladder Symptom Score (OABSS) total score >2 and DO and/or small MCC defined as <65% of expected bladder capacity (EBC) for age. OI was calculated as (1 - (median (all voided volumes in FVC in ml))/(0.65 ∗ EBC in ml)) ∗ 100. At baseline, 26 patients (36.1%) had DO and small MCC, while 21 patients (29.2%) only had DO. In 18 patients (25.0%) only small MCC was found. Seven patients had normal findings and 20 did not perform a urodynamic study. OI≥23 returned as a single significant predictor of OABSS >2 (OR 7.97, 95% 1.97-32.22, p=0.004) in multivariate regression (R2=30.8%; AUC=0.86). OI correlated with "urgency episodes over two weeks" and MCC/EBC with medium (r=0.45) and large effect (r=-0.56), respectively, p=0.001. A strong correlation of OI and MCC/EBC ratio is useful, as rise in MCC is predictive of a positive outcome. Also, calculating the OI is more practical than performing UDS. This could contribute to the use of OI as a predictive marker for starting (or continuing) anticholinergic treatment (when OI≥23) or for maintaining urotherapy alone (when OI<23) in children with OAB. The limitations were lack of external validation of OI, a 37-49% drop-off rate for follow-up visits at 3 and 6 months, respectively, and not performing UDS on all participants at every follow-up visit. OI was found to be a significant predictor of the presence of OAB symptoms and correlated with the number of urgency episodes. It could estimate how much MCC differs from EBC.

НЕЙРОУРОЛОГИЧЕСКОЕ ОБСЛЕДОВАНИЕ И ЛЕЧЕНИЕ ДЕТЕЙ, ОПЕРИРОВАННЫХ ПО ПОВОДУ СПИННОМОЗГОВОЙ ГРЫЖИ

Among the most severe consequences of spinal hernia surgery (SHG) are spinal neurogenic bladder (SNGB) and impaired bowel movement. SNGB, in addition to its main manifestations in the form of violations of the accumulative function of the bladder and the function of emptying, is dangerous for the development of complications – vesicoureteral reflux, ascending infection of the urinary system and chronic kidney disease. Clinical manifestations of SNGB do not always accurately indicate a variant of bladder dysfunction. The authors presented variants of the results of urodynamic studies in children operated on for SHG SHG. The state of the detrusor – hyperactivity or atony and the sphincter – insufficiency or hyperactivity and the selection of a pathogenetically justified treatment option are described.

Evaluation of bladder and bowel functions in children with microcephaly and congenital zika syndrome

Children with Congenital Zika Syndrome (CZS) present structural cortical changes that may compromise the integrity of their connections with urinary and digestive systems, causing bowel and bladder dysfunctions. To evaluate bladder and bowel dysfunction (BBD) in children with CZS. This is an observational cross-sectional study of a series of CZS cases. Urinary tracts were investigated using a bladder function protocol consisting of clinical history, detailed physical examination, laboratory tests, ultrasound of the lower and upper urinary tracts, and urodynamic evaluation. The bowel function protocol expanded anamnesis with questions related to signs and symptoms of functional disorders, Bristol scale, and ultrasound of the rectal ampoule. Forty children with CZS, aged between one and five years were included. The majority (80%) had bladder and bowel dysfunction (BBD), 12.5% had bladder dysfunction only, and 7.5% only bowel dysfunction. A reduced bladder capacity was confirmed in 36 patients (90%), while 15 (40%) presented postvoid residual greater than 20% of their cystometric capacity. Thirty-five patients (87.5%) presented four signs/symptoms of functional bowel disorders and the rectal ampoule ultrasound was >2.9cm in 21 (52.5%). Moreover, 19 (47.5%) presented urinary tract infection, while 5 (12.5%) developed pyelonephritis and required hospitalization. Renal ultrasound showed nephrolithiasis in three (7.5%), one (2.5%) presented horseshoe kidney, and a duplicated collecting system was found in three patients. Cryptorchidism was presented in eight (34%). Our study confirmed the presence of BBD in 80% of the children with CZS studied in this series. This is the first time that bowel dysfunction is confirmed in the settings of CZS. This recognition will facilitate early identification and appropriate therapies in an attempt to reduce complications. One limitation of the study is the absence of a control group. Due to the new aspects of CZS, it has been difficult to find a suitable group of patients with neurological disorders to compare and performing urodynamic studies in children without neurological or non-neurological voiding dysfunction is unethical. Appropriate control groups for future studies may be children with microcephaly due to other causes or older children with CZS who were not yet investigated or treated. Another limitation is the lack of a standard quantitative evaluation of bowel dysfunction in children with neurological disorders. Bladder and bowel dysfunction was confirmed in 80% of the children with CZS. This is a new Zika virus-associated neuromuscular disorder that needs to be further investigated.

Can rectal catheters be avoided during paediatric urodynamic studies?

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

Urodynamic Study in Children

A b s t r a c t: Urodynamic study (UDS) is a serial of clinical tests, like uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure pressure. These tests include urethral pressure profilometry and also measurement of the leak-point pressure of lower urinary system. UDS is one of the essential clinical studies in children complaining of voiding dysfunction, neurogenic bladder, urine incontinence, enuresis and another lower urinary tract symptom. The aim of proper bladder management in these patients is to maintain the lower urinary tract to have good capacity, low pressure, preventing infection and incontinence. Long term goal is preventing any undue damage to the upper urinary tracts and intact kidneys function. This review article of pediatric urodynamic study provides a classified diagnostic approach to bladder dysfunctions in children.

The Effects of Voiding Habits on Uroflowmetry in Childhood

Background: Urodynamic studies (UDS) is a simple non-invasive test to assess lower urinary tract function but it may be affected by several factors includes age, sex, voiding volume and voiding position. These interventional parameters become more highlighted while performing UDS in children whose emotional stress control and coping with unfamiliar situation is more difficult. Methods: Seventy six primary school age healthy children underwent screening uroflowmetry in different voiding positions voluntarily. Cases with urinary symptoms, other coexisting diseases, voiding volume less than 20cc or staccato voiding curve were excluded. Washrooms were designed in both western and eastern styles. UDS indexes were compared regarding voiding habits. Results: Comparison of uroflowmetric indexes between different genders and voiding positions showed differences which were not statistically significant but considering the voiding habits, uroflowmetric indexes were significantly different in familiar compare to unfamiliar voiding position. Q-Max was lower and time to Q-Max and micturition time were longer in unfamiliar voiding position. Conclusions: Urodynamic studies in children should be performed in preferred voiding position for each kid considering the culture and voiding habits. Unfamiliar voiding position may turn the uroflowmetry to a stressful experience for child that make him uncooperative and cause misleading results.

Urodynamic Findings in Adults With Moderate to Severe Cerebral Palsy

To determine urodynamic studies (UDS) findings in adult cerebral palsy (CP) patients. CP patients may suffer from voiding dysfunction. UDS in children with CP has consistently shown an upper motor neuron bladder with detrusor-sphincter dyssynergia. We included adult CP patients seen at Gillette Transitional Urology Clinic who underwent UDS for voiding dysfunction between 2011 and 2014. Descriptive statistics were used to characterize findings. There were 49/211 CP patients who underwent UDS. Average age was 30 years; 55% were men. Ninety-eight percent had moderate to severe CP. UDS was initiated for irritative symptoms in 55%, obstructive voiding symptoms in 25%, hydronephrosis in 18%, and other reasons in 2%. Incontinence was reported in 57%. Detrusor-sphincter dyssynergia was seen in 12%, detrusor overactivity in 30%, and detrusor leak point pressure (DLPP) >40 cmH2O in 51%. Median compliance was 18 mL/cmH2O (0.78-365). Maximum cystometric capacity (MCC) was 80-1400 mL and was <300 mL in 27%. Sixteen percent had an MCC <300 mL and a compliance <20 mL/cmH2O. Twelve percent had an MCC <300 mL and a DLPP >40 cmH2O. UDS findings in symptomatic adult CP patients are varied. Fifty-one percent had upper motor neuron bladder findings, similar to that seen in the pediatric literature, but 6% had large flaccid bladders. Half of the patients had concerning findings, such as compliance <20 or DLPP >40 cmH2O. Our results emphasize the need to thoroughly investigate voiding dysfunction in those with CP. Further characterization of this population is needed to correlate these UDS findings with clinical outcomes.

Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation

The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.

International Children's Continence Society standardization report on urodynamic studies of the lower urinary tract in children.

The objective of this document created by the ICCS standardization subcommittee is to provide a uniform guideline on measurement, quality control and documentation of urodynamic studies in children. This guideline was created using expert opinion and critical review of the published literature on urodynamic studies in children. Currently no standardized guideline or level 1 data exists on the proper technique for this subject matter. The document provides a throughout explanation on how to approach a child who presents with lower urinary tract dysfunction, whether it be of neurogenic, anatomic or functional origin. Formation of an urodynamic question after a comprehensive history and physical examination is paramount in selecting the urodynamic study(ies) that will be most appropriate for each child. Appropriate application of each test with careful consideration of the needs of the child and family will provide the most accurate and reproducible results. Recommendations on how to execute each of the components of an urodynamic study as well as interpretation are included in the document. Urodynamic studies have become a major tool in evaluating lower urinary tract dysfunction in children. There are many subtleties in performing these studies in children in juxtaposition to adults; therefore, adaptations specific to children must be made to achieve accurate and reproducible results. Uniformity in how the studies are conducted from center to center will allow for healthier transparency and enhanced comparison of results in both clinical and research situations.

Progress of application of urodynamics in children with voiding dysfunction

Voiding dysfunction is common in children, urodynamic study is necessary to evaluate voiding dysfunction.Recently, urodynamic studies in children with voiding dysfunction have been performed with increasing frequency as the techniques have been applied in most hospitals widely.New technologies, such as ultrasound urine flow in newborns and ambulatory urodynamics monitoring in children, have been used.Urodynamic has been used routinely in children with neurogenic bladder in China.This review summarized the application of urodynamics in children with voiding dysfunction and the relevant terminologies in pediatric urodynamics, in order to provide a reference for clinical applications and researches. Key words: Urodynamic; Voiding dysfunction; Child; Diagnosis

Ambulatory urodynamic studies (UDS) in children using a Bluetooth‐enabled device

• To report the early observations of using ambulatory urodynamic studies (UDS) using a Bluetooth-enabled device in children • To evaluate the incremental value of ambulatory over conventional UDS. • Ambulatory UDS were performed in selected children with voiding dysfunction between August 2009 and October 2010. • Conventional UDS were concurrently performed wherever possible. • The test results and treatment consequences of the two tests were compared. • In all, 12 ambulatory and seven conventional UDS were performed on 10 children (five boys, median [range] age 7 [4-16] years). • Six of the seven children had a normal conventional UDS. Ambulatory UDS detected phasic detrusor overactivity (DO) in five children and generalised DO in one. • Direct correlation of symptoms to DO was possible in two children during ambulatory UDS. Pressure rise during filling, seen in two children on conventional UDS, was not seen during ambulatory UDS. • Five children showed clinical improvement when therapy was guided by ambulatory UDS results. • Ambulatory UDS was generally well tolerated in eight children, with two complaining of discomfort. Inadequate information was obtained in two children who underwent ambulatory UDS due to technical problems in one and distress induced by the UDS in the other. • Ambulatory UDS provides useful additional information over conventional UDS and can be used to guide further therapy in selected children with voiding dysfunction. • It is safe and well tolerated in children. • There is a need for explicit guidance for the technical delivery and interpretation of ambulatory UDS in children.

Editorial Comment

Multiple previous authors have noted the association between high end filling detrusor pressures, detrusor overactivity, decreased bladder compliance/capacity, or high voiding pressures coexisting with high-grade reflux. Some have hypothesized that these patterns represent a developmental stage of normal bladder control and will resolve with time. Is There Any Role for Urodynamic Study in Children with High-grade Vesicoureteral Reflux?UrologyVol. 79Issue 4PreviewTo determine the clinical symptoms and urodynamic characteristics among children with primary high-grade vesicoureteral reflux (VUR). Full-Text PDF

Is There Any Role for Urodynamic Study in Children with High-grade Vesicoureteral Reflux?

To determine the clinical symptoms and urodynamic characteristics among children with primary high-grade vesicoureteral reflux (VUR). We prospectively studied clinical symptoms and urodynamic parameters in 147 consecutive patients ≤ 12 years old with idiopathic high-grade VUR referred to our hospital. Of 147 patients with high-grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria (88.5% females, 11.5% males). The most common symptom was recurrent urinary tract infection (57%) and urgency (59%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic findings were observed in 23% of patients. Overactive bladder (74%), high-end filling pressure (72.7%), low-compliance bladder (56%), and low bladder capacity (51%) were the most common urodynamic reports in this study. Other urodynamic findings were underactive bladder (1.5%), hypersensitive bladder (1.5%), hyposensitive bladder (3%), and high capacity bladder (2.2%). Proper management of VUR is very important because of its harmful potential effects on kidney function in children. With regard to the issue that most children with grade III and higher VUR had overactive bladder, high-end filling pressure, and other urodynamic disorders in their urodynamic study, it seems that these urodynamic disorders could be the basic cause of reflux.

Commonly used intravenous anesthetics decrease bladder contractility: An in vitro study of the effects of propofol, ketamine, and midazolam on the rat bladder

Aim:This study was designed to test the hypothesis that propofol, ketamine, and midazolam could alter the contractile activity of detrusor smooth muscle.Materials and Methods:Four detrusor muscle strips isolated from each rat bladder (n = 12) were placed in 4 tissue baths containing Krebs-Henseleit solution. The carbachol (10 −8to 10−4mol/L)-induced contractile responses as well as 5, 10, 20, 30, 40, 50 Hz electrical field stimulation (EFS)-evoked contractile responses of the detrusor muscles were recorded using isometric contraction measurements. After obtaining basal responses, the in vitro effects of propofol, ketamine, midazolam (10−5 to 10−3 mol/L), and saline on the contractile responses of the detrusor muscle strips were recorded and evaluated.Results:All the 3 drugs reduced the carbachol-induced and/or EFS-evoked contractile responses of rat detrusor smooth muscles in different degrees. Midazolam (10−4 to 10−3 mol/L) caused a significant decrease in the contractile responses elicited by either EFS or carbachol (P=0.000−0.013). Propofol (10−3mol/L) caused a decrease only in EFS-evoked contractile responses (P=0.001−0.004) and ketamine (10−3mol/L) caused a decrease only in carbachol-induced contractile responses (P=0.001−0.034).Conclusion:We evaluated the effects of the 3 different intravenous anesthetics on detrusor contractile responses in vitro and found that there are possible interactions between anesthetic agents and detrusor contractile activity. The depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol. Despite the necessity of further studies, it could be a piece of wise advice to clinicians to keep the probable alterations due to intravenous anesthetics in mind, while evaluating the results of urodynamic studies in children under sedation.

SACRAL NEUROMODULATION FOR THE TREATMENT OF REFRACTORY VOIDING DYSFUNCTION IN THE ELDERLY POPULATION

We hypothesized that warm infusion solution should be used for urodynamic studies in children because it more closely simulates normal physiology. Thus, we conducted a prospective randomized study comparing consecutive room temperature (RT) and body temperature (BT) cystometrograms (CMG) in the same child.Subjects underwent identical CMGs using RT and BT saline in random order. Maximum cystometric bladder capacity (CBC), pressure at CBC, uninhibited detrusor contractions, detrusor leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure, residual urine and pressure specific volumes below 20 and 30 cm water were compared. Data were analyzed using ANOVA, t test, and chi-square.RT and BT CMGs in 44 males and 47 females with a mean age of 8.6 years were compared. Of the children 58 (64%) had spinal dysraphism, 8 (9%) had cerebral palsy, 5 (6%) had posterior urethral valves and 20 (21%) had recurrent urinary tract infection, daytime incontinence or frequency/urgency symptoms. Maximum CBC, pressure at CBC, and pressure specific volumes below 20 and 30 cm water were significantly lower (10% to 15%) during BT cystometry. Maximum flow rate was higher with BT saline. Detrusor leak point pressure, pressure at maximum flow, maximum voiding pressure, and residual urine did not differ. Uninhibited detrusor contractions were more frequent during RT infusions. No gender differences were found. The discrepancies between RT and BT cystometry were most prominent in infants, children with spinal dysraphism and children with large bladders.There is a difference between cystometries performed using RT and BT saline. Capacity, storage variables and detrusor activity are diminished during BT cystometry. Although statistically significant differences were found between consecutive RT and BT CMGs, the magnitude of the difference may not be clinically relevant to change management. As such, we do not believe it is necessary to use warm infusion solution on a systematic basis for urodynamic studies in children. However, for children younger than 2 years when the magnitude was more relevant, the use of warm solution is recommended.