Uroflowmetry In Children Research Articles

A comparative study between EMG uroflowmetry with and without a catheter in children

ObjectivesTo evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test.MethodsA retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark.Results104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value < 0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the PF studies and non-invasive uroflowmetry, respectively. PF studies demonstrated a specificity of 39% (95% CI 23–57) and a positive predictive value (PPV) of 61% (95% CI 53–67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value = 0.5).ConclusionThe accuracy of PF studies in children, primarily in boys, compared to the non-invasive uroflowmetry, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment.

Evaluation of bladder dysfunction in children and adolescents with type 1 diabetes mellitus by uroflowmetry.

Diabetic cystopathy is a condition characterized by decreased bladder sensitivity, increased bladder capacity, decreased bladder contractility and increased residual urine volume. It can also be considered as an early indicator of autonomic dysfunction. In this study, it was aimed to evaluate bladder functions by uroflowmetry in children and adolescents with the diagnosis of type 1 diabetes mellitus. Type 1 diabetes mellitus children and adolescents were applied uroflowmetry and post-void residual urine volumes were evaluated. The physical examination findings of the patients and the laboratory data of diabetes control were obtained from the clinic files. A total of 51 cases aged 72-216 (155.6±35.4) months were enrolled into the study. Diabetes age of the cases was 66.5±46.2(13-180) months. The last one year average of HbA1c of the patients was found to be 9.7±1.9%. A total of 9.8% had good, 39.2% moderate and 51% poor metabolic control, respectively. While urodynamic evaluation was normal in 36 (70.6%) of 51 participants, voiding dysfunction was found in 15. There was no statistically significant difference between groups with and without voiding dysfunction in terms of age, gender, duration of diabetes, metabolic control and HbA1c values. It is very important to follow up patients with type 1 diabetes mellitus in terms of autonomic dysfunction. Diabetic bladder clinic, which can be observed independently of diabetes duration and metabolic control, is also included in this status. Urodynamic evaluation will be helpful both in demonstrating bladder dysfunction and in preventing possible complications.

How Valuable is Uroflowmetry in Children with Enuresis Nocturna?

Abstract Objective: Enuresis nocturna is an important social and psychological problem in children. Uroflowmetry (UF) is a noninvasive urodynamic test that is performed in daily clinical practice to evaluate urinary function. In UF evaluation, urine amount, urination time, latency time, maximum urine flow rate access time, maximum urine flow rate, and mean urine flow rate are evaluated. The objective of the study was to evaluate the UF results of children with primary nocturnal enuresis (PNE). Materials and Methods: The UF findings of healthy and visualized children without any urinary symptoms and who were prospectively admitted to the urology and pediatric surgery outpatient clinic with the complaint of PNE were compared. Information and UF results of PNE and healthy children included in the study were recorded. In this research, we compared the clinical characteristics and features of bladder assessment: UF, postvoid residuals, and bladder wall thickness between boys and girls with PNE and the clinical characteristics and bladder assessment between children with primary and secondary PNE. Results: A total of 183 children, comprised 103 potty-trained children with PNE and 80 potty-trained healthy children were included in the study. There were 60 children in the PNE group and 62 children in the control group. There was no statistically significant difference between the groups in terms of age. When the UF findings of both groups were compared, it was found that only maximum flow was higher in the children with PNE. In other parameters, there was no difference between the two groups. The Qmax in the group with PNE and the control group was found to be 20.48 ± 6.57 ml/s and 17.22 ± 6.17 ml/s, respectively (P = 0.001). Conclusions: The present study reveals that there is no difference between patients with enuresis nocturna and healthy individuals in terms of UF. Therefore, UF is not recommended for use in differential PNE diagnosis.

Correspondence of uroflowmetry and voiding diary in evaluation of voiding volume in children with lower urinary tract dysfunction

BackgroundObjective assessment of voided volumes in children with lower urinary tract dysfunction is important. This study aimed to compare and evaluate voided volumes obtained from a 48-h voiding diary and uroflowmetry in children with lower urinary tract dysfunction.MethodsIn this retrospective cohort study, voided volumes obtained by 48-h voiding diary and contemporaneous uroflowmetry were compared in terms of age, sex, and the three most common subtypes of lower urinary tract dysfunction (monosymptomatic nocturnal enuresis, overactive bladder, and dysfunctional voiding) in children. Patients were stratified according to voided volume differences between uroflowmetry and 48-h voiding diary.ResultsA total of 242 children were included in the study. Maximum and average voided volumes in uroflowmetry were higher than those in 48-h voiding diaries in the entire population (P < 0.001). While there was a significant difference between maximum voided volume in the two methods when evaluating patients with overactive bladder and dysfunctional voiding, there was no significant difference in those with monosymptomatic nocturnal enuresis (P = 0.001, P = 0.030, P = 0.206, respectively). A significant difference was observed between the three subtypes of lower urinary tract dysfunction in voided volumes (P < 0.001). When maximum and average voided volumes were compared for age subgroups, there was no significant difference in maximum and mean voided volumes only in voiding diary measurements (P > 0.05). When the two methods were compared, there was a difference in maximum and average voided volumes of more than 30% of the estimated bladder capacity in 94 (38.9%) and 86 (34.3%) children, respectively.ConclusionsUroflowmetry and a 48-h voiding diary should not be used interchangeably when evaluating children with lower urinary tract dysfunction. The results of uroflowmetry measurements should be used to support the diagnosis of underlying lower urinary tract dysfunction.

Role of uroflowmetry in children with ano-rectal malformation in anticipating upper urinary tract damage

Role of uroflowmetry in children with ano-rectal malformation in anticipating upper urinary tract damage

Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage. Aim: To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM. Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure. Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1). Conclusion: Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage.

A quantitative approach to the interpretation of uroflowmetry in children.

We hypothesized that by correcting for volume and creating a flow index (FI) we could develop a reproducible and reliable means to estimate flows in children without the use of a flow nomogram. Our second hypothesis was that this volume corrected FI could define objective parameters for the different flow curves that are described in the ICCS document. Uroflowmetry curves of 1,268 healthy children were analyzed. Quadratic equations using nonlinear regression for both sexes were generated for each set of presumed normal voiders (learning data) (NV). The NV test data were used to verify the equations. Linear regression analysis was used to compare the variance between actual and estimated flow rates. A FI (Actual Qavg/Estimated Qavg) was created and ROC analysis for all flow types was performed. Sensitivity and specificity analysis was performed on all voids to validate the accuracy of the FI to predict flow pattern. Analysis of the FI from the first void to the second confirmed the accuracy and reproducibility in both males and females using various means of analysis. ROC analysis shows that there are very strong AUC's for Bell, plateau, and tower flow patterns. Sensitivity and specificity analysis reveals that defined FI parameters are able to predict the flow patterns. Our predictive formulas allow for direct comparison of one flow to the next in a single patient when the FI is used. Utilizing the FI, we can predict the type of flow pattern removing subjectivity from the analysis of uroflow patterns. Neurourol. Urodynam. 35:836-846, 2016. © 2015 Wiley Periodicals, Inc.

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.

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.

The correlation between bladder volume wall index and the pattern of uroflowmetry/external sphincter electromyography in children with lower urinary tract malfunction

ObjectiveTo evaluate the relationship between bladder volume wall index (BVWI) and the pattern of uroflowmetry in children with lower urinary tract malfunction. Patients & methods91 children aged 4–15 years with history of bladder dysfunction and 59 age/sex-matched healthy children with negative urine culture in previous month were enrolled. Uroflowmetry and kidney and bladder sonography were performed in all children. BVWI was measured by dividing maximum bladder volume index by mean bladder thickness. It was expressed as percentage by dividing calculated BVWI by expected BVWI, and values between 70% and 130% were presumed normal. Urodynamic study was done in symptomatic cases. ResultsThe bladder was thick (<70%) in 39 (28 cases, 11 controls) and thin (>130%) in 35 (18 cases, 17 controls) (P > 0.05). Uroflowmetry was abnormal in 82 (61 cases, 21 controls) (P < 0.05). Severe sphincter dyssynergia was detected in 47% of cases compared with 20% of controls (P < 0.05).There was no relationship between BVWI and uroflowmetry in cases or in controls (P > 0.05). The median post-void residual urine was not statistically different between the groups (20 vs 12.3 ml) (P > 0.05). When both bladder sonography and uroflowmetry were abnormal, they had an association with abnormal urodynamics (P < 0.05). ConclusionAmong children with lower urinary tract dysfunction, the pattern of uroflowmetry could not be predicted from the BVWI, but in cases with combined abnormal bladder sonography and uroflowmetry results, there was a significant association with an abnormal urodynamic study.

Uroflowmetry in Children can be Simply Classified as Normal or Abnormal Pattern

Uroflowmetry in Children can be Simply Classified as Normal or Abnormal Pattern

What is the Variability in Urodynamic Parameters With Position Change in Children? Analysis of a Prospectively Enrolled Cohort

Insufficient data are available regarding the effect of patient position on urodynamic parameters and diagnoses in children. We report on a cohort of pediatric patients, comparing the results of serial urodynamic studies to determine the variability between the supine and sitting positions. Children referred for urodynamic evaluation were prospectively enrolled based on the ability to tolerate position change. Consecutive studies in supine and sitting positions were performed during a single session by the same nursing team. Volume infused and infusion rate did not differ with position change. A total of 48 children were enrolled in the study. Mean patient age was 10.4 years. No statistically significant difference was noted for maximum cystometric capacity, detrusor leak point pressures or pressure specific volumes at 20 and 30 cm water between the supine and sitting positions. Statistically significant lower values were found for the volume of first sensation and volume at which detrusor overactivity was first detected (p <0.05), with a trend toward significance for abdominal or Valsalva leak point pressure. Statistically significant differences were also noted with position changes in regard to detection of detrusor overactivity and incontinence episodes (p <0.05). In our study population no significant differences were detected in several urodynamic parameters with position change, suggesting that clinically valid conclusions can be obtained by performing the study in either position. Studies in the sitting position allow for increased detection of detrusor overactivity and incontinence, thus, being favored over the supine position if well tolerated by the child.

Uroflowmetry in Children - Is It Necessary to Repeat the Study in a Single Patient?

Uroflowmetry, as the only non-invasive urodynamic means of assessing the function of the lower urinary tract is widely used in children. A possible psychological influence on the results is the reason why uroflowmetry is often repeated in the same patient. The investigation was conducted to compare parameters of repeated uroflowmetry in a single child with the results of single uroflowmetry performed in a group of children. The goal of the study was to evaluate the efficacy of a single uroflow procedure in children. A single uroflowmetric study was performed in 44 children aged from 9 - 11 years (mean 10 yrs). Out of the group one child was chosen who had 32 successive uroflow attempts. The range and average values of the uroflowmetric parameters were compared in both groups. Pearson's correlation coefficient was used for calculation and for a comparison of the uroflowmetric parameters of both groups (significance level p < 0.05). Average values of the voided volume, maximal and average flow were lower in the 32 attempts of a single child than in the control group (44 attempts). The values of the Pearson's correlation coefficient were ranged from 0.2 to 0.4 for flow/voided volume ratio and from 0.4 to 0.8 for flow time/voided volume ratio in both groups. There were no differences between the values in both groups apart from flow time/voided volume correlation (significance level p < 0.05). Repetition of uroflowmetric study does not seem to improve the efficacy of the modality in assessing voiding function in children.

On the issue of uroflowmetry in children

In the present work we consider uroflowmetry as a promising method of functional diagnostics in pediatric urological practice. Uroflowmetry is a method based on the measurement of volume urinary flow rate (VUR). The following parameters are recorded graphically: duration of urination, average urine flow rate, urine flow rate in the first second, time of reaching maximum urine flow rate, maximum urine flow rate and bladder volume.

Device for uroflowmetry in children

It is known that uroflowmetry has significantly expanded the diagnostic capabilities of urological studies. There is no doubt about the need for widespread use of uroflowmetry in daily pediatric urological practice.