Urodynamic Traces Research Articles

111 - Refining and using Bristol UTraQ to score the quality of urodynamic traces

111 - Refining and using Bristol UTraQ to score the quality of urodynamic traces

The curriculum and learning outcomes of a short course in urodynamics

Quality diagnostics require good staff training. In urodynamics, it is helpful to have an introductory training course in both technical and clinical skills before patient clinics commence. It is also beneficial to revise the basic principles and practices after some initial clinical experience. To this end, our Institute has been running short courses in urodynamics for over a decade. These have taken place at the annual scientific meetings of the International Continence Society and of the European Urological Association. In the hope that the structure, curriculum and learning points will be useful for other centres who want to run a similar course, we share these here. We emphasise that a practical, hands-on approach with demonstration equipment and urodynamic traces has been well received.

Design, implementation and assessment of a novel, introductory curriculum into female, neurological and urodynamic urology: a 7-year experience of urology simulation bootcamp course.

To present the seven-year experience of a multi-component and interactive module on female, neurological and urodynamic urology (FNUU) training at the UK National Urology Simulation Bootcamp Course (USBC) and demonstrate trainee satisfaction and competency progression. During the week-long USBC, a four-hour module on FNUU was designed which consisted of short interactive presentations with an emphasis on practical stations in urodynamics, intravesical botulinum toxin injection, urethral bulking injection, female pelvic examination and, initially, mid-urethral tapes (subsequently replaced with percutaneous sacral nerve evaluation). The trainee's level of knowledge, operative experience and confidence were assessed pre- and post-course. The practical assessment consisted of preparation and intravesical administration of botulinum toxin, female pelvic examination, urodynamic trace interpretation or mid-urethral tape simulation. Trainee feedback was also collected. Two-hundred sixty-one newly appointed urology trainees participated in the USBC during this period. A high level of satisfaction was constantly reported. The highest rated session was urethral bulking with 72% being very satisfied, followed by Botox and urodynamics. The final assessment showed 70% had achieved level 4 competency in cystoscopy and Botox. Qualitative feedback was also obtained. To our knowledge, this is the first module of its kind, and it shows that it is feasible to develop, implement and evaluate an introductory curriculum into FNUU that is reproducible over a 7-year period with very positive feedback.

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Editorial Comment.

No AccessJournal of UrologyPediatric Article22 Feb 2023Editorial CommentThis article comments on the following:Deep Learning of Videourodynamics to Classify Bladder Dysfunction Severity in Patients With Spina Bifida Leslie M. Peard and Cyrus M. Adams Leslie M. PeardLeslie M. Peard Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee More articles by this author and Cyrus M. AdamsCyrus M. Adams Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003267.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Translating pediatric urodynamics from clinic into collaborative research: lessons and recommendations from the UMPIRE study group. J Pediatric Urol.2021; 17(5):716-725. Crossref, Medline, Google Scholar 2. . Interrater reliability in interpretation of neuropathic pediatric urodynamic tracings: an expanded multicenter study. J Urol.2018; 199(5):1337-1343. Link, Google Scholar 3. . Machine learning for urodynamic detection of detrusor overactivity. Urology.2022; 159:247-254. Crossref, Medline, Google Scholar 4. . Deep learning of videourodynamics to classify bladder dysfunction severity in patients with spina bifida. J Urol.2023; 209(5). Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology14 Feb 2023Deep Learning of Videourodynamics to Classify Bladder Dysfunction Severity in Patients With Spina Bifida Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leslie M. Peard Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee More articles by this author Cyrus M. Adams Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee More articles by this author Expand All Advertisement PDF downloadLoading ...

This Month in Pediatric Urology.

No AccessJournal of UrologyThis Month in Pediatric Urology20 Feb 2023This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003374AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "This Month in Pediatric Urology." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . 10 Amazing example of how deep learning AI is used in practice. Forbes.2018; 20. Accessed February 5, 2023. Google Scholar 2. . Deep learning of videourodynamics to classify bladder dysfunction severity in patients with spina bifida.J Urol.2023; 209(5):000-000. Google Scholar 3. . Interrater reliability in interpretation of neuropathic pediatric urodynamic tracings: an expanded multicenter study. J Urol.2018; 199(5):1337-1343. Link, Google Scholar 4. . Animal Tool Behavior, revised edition. Johns Hopkins University Press; 2011. Crossref, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Wan More articles by this author Expand All Advertisement PDF downloadLoading ...

Statistical process control for the analysis of quality control in urodynamics: A potential new approach for quality review of urodynamics.

To analyze quality control in urodynamic studies, using a proportion control chart (p-chart) for statistical process control. This single-center study was conducted at the Urodynamic Center of West China Hospital, Sichuan University. We randomly selected 15 samples from each month in 2020, and 180 urodynamic traces were finally enrolled. We used the p-chart of statistical process control for analysis. We calculated the proportion of the incidence of a selected set of artefacts in the monthly urodynamic study process, including non-standard zero setting, no cough test, incomplete records of all measurements by urodynamicists, catheter displacement, and baseline drift. Through the specific calculation formula of statistical process control, we obtained the values of the center line, lower control limit, and upper control limit. All data points of each artefact were within zone A. However, one outlier was found in the p-chart of all artefacts in October, which might have been caused by inexperienced operators. Statistical process control may play an important role in the process control of urodynamic studies and guide us in identifying the cause of poor quality in process management.

Typical value ranges and signal patterns in patients with neurogenic bladder: Quality control in urodynamics using an air-charged catheter system.

To establish typical value ranges (TVRs) of the air-charged catheter (ACC) system, and analyze the typical signal patterns (TSPs) of cough under different bladder volumes for quality control of a urodynamic study using the ACC system. The urodynamic traces of 1977 patients with neurogenic bladder (NB) were analyzed for intravesical pressure (pves ), abdominal pressure (pabd ), and detrusor pressure (pdet ) in the cough test at our center from July 2017 to December 2021. The pdet cough signals were described and classified. The pdet cough signal patterns in different bladder volumes and postures were analyzed. The 50% range of the initial resting pves , pabd , and pdet in the supine and sitting positions were 7-15, 7-14, and 0-0 cmH2 O, and 24-33, 24-33, and 0-0 cmH2 O, respectively. The cough amplitudes for pves and pabd were similar in the 50% range, as follows: 10-27 and 8-25 cmH2 O in the supine position, respectively; and 18-43 and 17-40 cmH2 O in the sitting position, respectively. The cough amplitude of pves and pabd was not related to bladder volume (p > 0.05). The cough spikes of pdet were divided into three types: type I, in which pdet has a minimal change (<5 cmH2 O); type II, a monophasic cough spike, in which could be a positive (IIa, ≥5 cmH2 O) or negative spike (IIb, ≥5 cmH2 O); and type III, a biphasic spike, in which could be a positive-to-negative biphasic (IIIa) or negative-to-positive spike (IIIb). Under different bladder volumes, the cough signals of pdet were all expressed as type I, II, or III, and the cough signals were unrelated to bladder volume (p > 0.05). TVRs of the initial resting state in patients with NB were established to provide guidance for quantitative quality control of the ACC system. The TSPs of the pdet cough signal under different bladder volume and posture were described, which could be used for qualitative quality control of the ACC system.

Bristol UTraQ: A proposed system for scoring the technical quality of urodynamic traces.

To develop and test a scoring system for the technical quality of a urodynamic trace METHODS: Rasch analysis was used to select the most discriminating questions relating to good urodynamic practices. The questions were taken from International Continence Society standard documents and tested on 60 traces of varying quality and from different sources. Twenty-five questions were selected by this process. These were tested with 10 traces by seven scorers, and with 60 traces by a single scorer. A pass quality score of 75% resulted in good discrimination between good and poor traces. Further editing and clarification resulted in a final score sheet of 23 Yes/No questions. A proposed scoring system, "Bristol UTraQ," for the technical quality of urodynamic traces has been developed and tested. We suggest a score above 75% indicates acceptable trace technical quality. High technical quality is the essential first step in ensuring that urodynamic studies can answer the urodynamic questions for every patient. Plans for further validation are outlined.

Underactive Bladder Syndrome: An Often Overlooked Condition

Urinary bladder outlet obstruction can cause lower urinary tract symptoms in men and women, such as a weak or interrupted urine stream, straining to void, hesitancy, and the feeling of incomplete bladder emptying. These symptoms can also be associated with underactive bladder syndrome. This urological condition has a high prevalence in both genders, especially in older age groups. The most common risk factors that can contribute to the pathogenesis of underactive bladder syndrome are aging, detrusor myopathy, neuroinflammatory, neurodegenerative and other lesions of the central and peripheral nervous system, and diabetes mellitus. Reduced detrusor contractility, or detrusor underactivity, is the most common pathology of underactive bladder syndrome. Detrusor underactivity is a urodynamic definition provided by the International Continence Society. The urodynamic trace is characterised by a low urine flow rate accompanied by low detrusor pressure or brief detrusor muscle contraction. Underactive bladder syndrome is often recognised and treated poorly in clinical practice because the symptoms are not specific. Furthermore, underactive bladder can be asymptomatic or coexist with bladder outlet obstruction and overactive bladder syndrome. The aim of this study was to review recent research concerning the aetiology, classification, diagnostic evaluation, and available treatment methods for patients with symptoms of underactive bladder syndrome. Making an accurate underactive bladder diagnosis is challenging because it is a multifactorial condition with various patterns of manifestation. Consequently, there is still no general agreement and standardisation regarding the most favourable diagnostic and therapeutical approach.

Reliability of the international spinal cord injury urodynamic basic data set version 1.0

A cross-sectional study. To assess interrater and intrarater reliability of the International Spinal Cord Injury (SCI) Urodynamic Basic Data Set (UBS) version 1.0. Urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital. Two raters independently analyzed urodynamic tracings from 50 patients and completed the UBS twice, each test 1 month apart. The interrater and intrarater reliability of this data set were analyzed using Kappa, Weighted Kappa, and the Intraclass correlation coefficient (ICC). Of the 50 patients, 72% were male. The mean (SD) age was 48.2 (16.6) years. The median time (IQR) since the injury was 27 months (0-101 months). The interrater reliability of the items of UBS were substantial to almost perfect (0.78-0.99). The intrarater reliability of the first rater was fair to almost perfect (0.37-1.00). The intrarater reliability of the second rater was moderate to almost perfect (0.51-1.00). Relatively low interrater and intrarater reliability were observed in bladder compliance and urethral function items. The first version of UBS has acceptable interrater and intrarater reliability on most items. Although bladder compliance and urethral function have problematic interrater and intrarater reliability, they have been adjusted in the second version. Due to its simplicity and reliability, UBS is clinically useful for urodynamic assessment in people with SCI.

A prediction model for detrusor overactivity at ambulatory urodynamics in women with urinary incontinence

Objective(s)To develop a multivariable model using both clinical examination findings and validated questionnaires’ scores for predicting the presence of detrusor overactivity observed during ambulatory urodynamic monitoring in women with urinary incontinence. Study DesignThe study population was chosen from a registry of women evaluated with urodynamics for urinary incontinence retrospectively. Data for baseline characteristics, clinical findings, and ambulatory urodynamic records were evaluated for all women included to the study. Urodynamic data were obtained by retrospective review of urodynamic traces with a standardized protocol during single voiding cycle, compatible to the standards of International Continence Society (ICS) for ambulatory urodynamic monitoring. ResultsA total of 395 women with urinary incontinence were included in the study. Detrusor overactivity was diagnosed in 57.1% of women included to the study. Clinical factors positively associated with detrusor overactivity were higher body-mass index (OR = 1.10; 95% CI 1.03−1.15, p < 0.001), higher OAB-V8 (Overactive bladder awareness tool - version 8) scores (OR = 1.04; 95% CI 1.01−1.06, p < 0.001) and presence of urgency urinary incontinence (OR = 2.39; 95% CI 1.47−3.81, p < 0.001). The presence of postural urinary incontinence (OR = 0.51; 95%CI 0.28−0.90, p = 0.021) and insensible loss of urine (OR = 0.33; 95%CI 0.27−0.93, p = 0.005) had negative associations with detrusor overactivity in the final multivariate logistic regression analysis. Conclusion(s)BMI, OAB-V8 scores, urgency urinary incontinence, postural urinary incontinence and insensible loss of urine were associated with the presence of detrusor overactivity according to our prediction model. However, the overall model accuracy suggests urodynamic studies are still needed for a definitive diagnosis. Nevertheless, the prediction may be beneficial for selecting a subgroup of women who are unlikely to benefit from ambulatory urodynamic monitoring for the diagnosis of detrusor overactivity.

MP31-10 COMPARISON OF INDICES FOR EVALUATION OF DETRUSOR CONTRACTILITY IN WOMEN

INTRODUCTION AND OBJECTIVE: To compare 3 contractility parameter indices, projected isovolumetric pressure (PIP-BCI), PIP1, and k from the VBN mathematical model, for women referred for evaluation of various lower urinary tract symptoms (LUTS) in relationship to age, presenting complaint and urodynamic diagnosis. METHODS: Urodynamic tracings of non-neurologic women referred for investigation of LUTS were retrospectively analyzed. All patients were evaluated with medical history, review of medications, bladder diary for at least 48h, physical examination and dipstick analysis. Each urodynamic session was performed using a urodynamic unit from Laborie (Mississauga Canada) and carried out according to the International Continence Society Good Urodynamic Practices.Bladder was filled with saline at room-temperature at a medium filling rate of 50 mL/min. Filling cystometrogram was obtained via a triple lumen urethral catheter 7F allowing for urethral pressure recording followed by an intubated flow (IF) During IF, pdet.Qmax and Qmax were measured. Post void residual volumes (PVR) were measured by Bladder-scan. The initial bladder volume or Vini was calculated by adding the voided volume to the PVR. Three age groups pre, peri and post-menopausal were compared. Excluded were women with UTI, stage >2 prolapse, no voiding during the study, or low volume voided. RESULTS: 449 urodynamic tracings met study criteria. Main complaint was incontinence, with a second group (Other) of 95 women with non-incontinence LUTS. PIP-BCI, PIP1 and k decreased significantly with ageing in each sub-group.PIP-BCI was significantly different between MUI and Other (p=.0259) while PIP1 was significantly higher in UUI vs. Other (p=.0161) and k in UUI vs. SUI (p=.0107), MUI (p=.0010) and Other (p=.0224).Low value of PIP-BCI for bladder outlet obstruction vs. detrusor overactivity while PIP1 and k values were high and similar for these two diagnoses and a high value of PIP-BCI for detrusor overactivity with impaired contractility close to the value for bladder outlet obstruction while PIP1 and k were low. CONCLUSIONS: Evaluation of detrusor contractility in women is easily obtained using indices PIP-BCI and PIP1 or using the VBN nomogram giving parameter k. PIP1 and parameter k produced comparable and consistent results with the urodynamic diagnosis while PIP-BCI leads to inconsistencies. Source of Funding: none

Neurogenic lower urinary tract dysfunction predicts prognosis in patients with multiple system atrophy.

To evaluate whether neurogenic lower urinary tract dysfunction and urodynamic parameters predict the outcomes of patients with multiple system atrophy (MSA). A retrospective study was performed in patients who were diagnosed with MSA and underwent urodynamic studies simultaneously from September 2014 to July 2018. The urodynamic traces were reviewed by urologists. Detrusor contractility was evaluated by the bladder contractility index (BCI) and Schäfer nomogram. Telephone follow-up was conducted in July 2019 to acquire survival data. Clinical and urodynamic parameters were analyzed for survival using Cox regression analysis. Overall, 70 MSA patients were eligible for analysis, and 61 of them underwent urodynamic study within 3years of initial symptom onset. The parkinsonian subtype of MSA (MSA-P) had a smaller proportion of men as well as longer motor and lower urinary tract symptom durations than the cerebellar subtype (MSA-C). MSA-P also had a lower mean BCI than MSA-C (32.0 ± 27.0 versus 53.6 ± 33.4, p = 0.025). The mean MSA survival time was 5.4 [95% confidence interval (CI) 4.8-6.3] years. Cox regression analysis showed that survival from baseline was correlated only with BCI [hazard ratio (HR) 0.983, 95% CI 0.969-0.997, p = 0.020]. Overall survival was correlated with BCI (HR 0.982, 95% CI 0.966-0.999, p = 0.039) and the presence of urinary incontinence (HR 3.007, 95% CI 0.993-9.220, p = 0.052). Detrusor contractility can be a prognostic marker in MSA patients. A high BCI value is a protective factor for survival from baseline and overall survival. The presence of urinary incontinence predicts shortened overall survival.

Comparison of indices allowing an evaluation of detrusor contractility in women

To compare 3 detrusor contractility indices, projected isovolumetric pressure (PIP-BCI), PIP1, and k from the VBN mathematical model, for women referred for evaluation of various lower urinary tract symptoms (LUTS) in relationship to age, presenting complaint and urodynamic diagnosis. Urodynamic tracings of non-neurologic women were analyzed. Three indices of detrusor contractility were measured from the pressure-flow study. Exclusion criteria were voided volume<100mL, stage>2 prolapse, interrupted flow, abdominal straining. Age sub-groups were pre-, peri- and post-menopause. Urodynamic diagnosis included incontinence findings and detrusor activity during voiding. Main complaint was incontinence (354 women); 95 women (Other) had non-incontinence LUTS. PIP-BCI, PIP1 and k decreased significantly with ageing in each sub-group. PIP-BCI was significantly different between MUI and Other (P=.0259) while PIP1 was significantly higher in UUI vs. Other (P=.0161) and k in UUI vs. SUI (P=.0107), MUI (P=.0010) and Other (P=.0224). Low value of PIP-BCI for bladder outlet obstruction vs. detrusor overactivity while PIP1 and k values were high and similar for these two diagnoses and a high value of PIP-BCI for detrusor overactivity with impaired contractility close to the value for bladder outlet obstruction while PIP1 and k were low. Evaluation of detrusor contractility in women is easily obtained using indices PIP-BCI and PIP1 or using the VBN nomogram giving indice-parameter k. PIP1 and parameter k produced comparable and consistent results with the urodynamic diagnosis while PIP-BCI leads to inconsistencies. 4.

Account for high flow rate-low detrusor pressure voids in female: Contribution of VBN model

Nomograms using the VBN model of women micturition allowed evaluating detrusor contractility (k) and urethral obstruction (U) from pressure-flow (PFs) recordings. While the model worked for most of the patients, an intriguing result, negative U value was observed for patients with high flow-low detrusor pressure (Qp voids). To explain that condition, our hypothesis was a weak urethral resistance to dilatation or increased expansibility (URD). The area offered to the fluid at each point of the urethra (its dilatation) is a function of the time depending difference between inside and outside pressures. In the VBN model, this function is sigmoid-like, the same for all women. For Qp voids, Qrecorded was more higher than it would be with the recorded pressure (VBN analysis). So, modeling allowed computing abnormally increased urethral wall expansibility (URD) whose consequence would be an increased flow. Among 222 non-neurologic women referred for investigation of various lower urinary tract symptoms, 27 (mean age 66.3±11.4 y) had Qp void: Qmax=27±6mL/s; pdet.Qmax =7.5±4.7cm H2O. Mean URD value was .36±.67. Introduction of URD in a modeled analysis of urodynamic traces led to a good fitting between recorded and computed traces for the 27 Qp. Mathematical modeling of micturition allows proposing an explanation of the unexpected observations of Qp voids. They would be due to abnormal urethral wall elasticity. Despite major challenges measurement of this elasticity would be the next step. 3.

High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections.

The aim of this study was to evaluate lower urinary tract dysfunction (LUTD) in women with recurrent urinary tract infections (UTIs). One hundred consecutive female patients with recurrent UTIs who underwent videourodynamic study (VUDS) were included. Another 25 women free from recurrent UTIs served as controls. All the underlying diseases, urine analysis and culture results, VUDS findings, and treatment outcomes of voiding dysfunction were carefully reviewed and analyzed. The mean age of the recurrent UTIs patients was 64.0 ± 16.0 years. Storage and voiding dysfunctions were found in 90 (90%) patients, including bladder neck dysfunction in 19 (19%), detrusor hyperactivity with impaired contractility in 6 (6%), detrusor overactivity in 5 (5%), detrusor underactivity in 10 (10%), dysfunctional voiding in 25 (25%), hypersensitive bladder in 6 (6%), and poor relaxation of the pelvic floor muscle in 20 (20%). Only 10 (10%) patients had normal urodynamic tracings. Compared with the controls, the recurrent UTI patients had significantly smaller cystometric bladder capacity, lower maximum flow rate, smaller voided volume, higher detrusor pressure, and larger PVR volume. However, only 6 (11.3%) patients with recurrent UTIs were free from subsequent UTIs following individualized treatment for their voiding dysfunction. A high incidence of vide urodynamic LUTD was identified in women with recurrent UTIs. Despite receiving individualized treatments based on their VUDS findings, only a small portion of these patients were subsequently free from UTIs.

Is bladder voiding efficiency useful to evaluate voiding function in women older than 65 years?

The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis. Urodynamic tracings of non-neurologic women referred for investigation of various lower urinary tract symptoms (LUTS) were analyzed. Urodynamic study included one FF followed by one cystometry and IF. Post void residual volume (PVR) was measured using a Bladder-scan. Exclusion criteria were voided volume<100ml and prolapse of grade>2. One hundred and ninety women met the study criteria. The mean age was 74±6 years [65-96years]. The main complaint was urinary incontinence: stress (26), urge (53) and mixed (56). Forty-four women had various complaints without incontinence. Overall BVE IF (77.6±25.8) was significantly lower than BVE FF (90.4±15.3) (P<.0001). Age sub-groups stratification led similar results. BVE IF was significantly lower than BVE FF in women with incontinence whatever the cause. Urodynamic diagnosis was posed according to the ICS/IUGA recommendations and 2 sub-groups defined according with involvement of detrusor. BVE IF was significantly lower than BVE FF for detrusor dysfunction, except for detrusor overactivity. In this large cohort of old non-neurologic women studied urodynamically for a variety of LUTS, BVE is higher when evaluated from a FF whatever age and for complaint of urinary incontinence. In addition, a low BVE value from an IF may suggest a detrusor dysfunction. 4.

Urodynamic factors associated with the large capacity bladder and incomplete emptying after prolapse repair (2009-2015).

To identify the clinical and urodynamic factors associated with the large capacity bladder and incomplete bladder emptying after prolapse repair. We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015. Women were stratified by urodynamic capacity. The primary outcome was incomplete emptying at the longest follow-up (postvoid residual [PVR] > 200 mL). Data were analyzed in the Statistical Analysis System software. Two hundred and sixty-six women (mean age, 61 years) had preoperative urodynamic tracings available for review. After surgery, there were 519 PVRs in 239 women recorded at up to 2949 days (mean, 396) and nine time points (median, 2; IQR, 1-3). The receiver operator curve for predicted probability of longest follow-up PVR greater than 200 mL (area under curve = 0.67) identified the 600 mL cutpoint which defined large capacity bladder. Large capacity bladders (capacity, >600 mL [n=79] vs ≤600 mL, [n=160]) had a mean: detrusor pressure at maximum flow (21 vs 22 cm H2 O; P = 0.717), maximum flow rate (19 vs 17 mL/s; P = 0.148), significantly elevated PVR (202 vs 73 mL; P < 0.001), and significantly lower voiding efficiency (VE) (74 vs 82%, P < 0.05). Following prolapse repair, elevated PVR was associated with large capacity (PVR 101 vs 49 mL, P < 0.05). Large bladders had a two- to three-fold risk of longest follow-up PVR greater than 200 mL (14.3%-20.3% [capacity, >600 mL] vs 4.1%-7.0% [capacity, ≤600 mL]). VE was similar after surgery regardless of the capacity (87% vs 88%, P = 0.772). The decision to pursue prolapse repair should be individualized and take into account, the bladder capacity and goals for PVR improvement after surgery.

This Month in Pediatric Urology

No AccessJournal of UrologyThis Month in Pediatric Urology1 May 2018This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.013AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Pediatric Urology." The Journal of Urology, 199(5), p. 1084 References 1 : Initial imaging for pediatric renal tumors: an opportunity for improvement. J Urol2018; 199: 1330. Link, Google Scholar 2 : Interrater reliability in interpretation of neuropathic pediatric urodynamic tracings: an expanded multicenter study. J Urol2018; 199: 1337. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 5May 2018Page: 1084 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Wan More articles by this author Expand All Advertisement PDF downloadLoading ...