Cystometry in infants and children with no apparent voiding symptoms

Abstract

Objective To evaluate bladder function in infants and children with no apparent voiding symptoms. Subjects and methods The study included 83 infants and children (51 boys and 32 girls, aged 3 days to 12 years) with no neurological and lower urinary tract pathology but who had undergone or were about to undergo surgery for upper urinary tract or other pathology. They were evaluated using slow‐filling cystometry, with simultaneous electromyography recorded using surface electrodes on the perineum. The voiding variables were compared among groups categorized by age, sex and body weight. Results In boys and girls, respectively, the mean (sd) post‐void residual urine volume (PVR) was 6.3 (3.9) and 5.4 (4.8) mL, the maximum detrusor pressure during voiding was 66.1 (13.1) and 56.6 (14.7) cmH2O and the maximum voiding pressure was 73.9 (16.6) and 62.7 (16.2) cmH2O. There was no significant difference in these variables between the sexes or between infants and children (P>0.05). Detrusor instability (DI) was apparent in nine of 83 (10.8%) infants and children and occurred in the late filling phase. Bladder capacity increased with age and body weight (from 30 mL in neonates to 350 mL in 12‐year‐old children), and mean (sd) bladder compliance increased with age, from 3.6 (0.5) mL/cmH2O in infants to 13.3 (3.0) mL/cmH2O in older children, at a filling rate of 5–7 mL/min. Conclusions In these infants and children with no apparent voiding symptoms, most bladders were stable, DI could occur in the late filling phase of cystometry, voiding was nearly complete, the PVR being usually <10 mL, and bladder capacity increased with age and body weight.

Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study

“…The maximum intravesical pressure during voiding recorded by a transurethral catheter in infants and children with no apparent voiding symptoms ranges from 56.6 ± 20.3 cmH 2 O in infants <1 yr to 70.7 ± 13.6 cmH 2 O in 12-year-old children [22]. In another study using suprapubic catheters, intravesical pressure and voiding detrusor pressures varied between 107 and 117 cmH 2 O in infants (3–10 months old); pressures were around 75 cmH 2 O in girls [23]. In infants with lower tract urinary dysfunction characterized by high voiding pressure levels, low bladder capacity, and dyscoordination at voiding, VUR is common with an estimated prevalence around 80% [24].…”

ICS educational module: Pressure flow study in children

“…The voiding phase begins when the child and the urodynamicist decide that “permission to void” has been given, or when involuntary voiding begins . This occurs when the maximum cystometric capacity (MCC) has been reached in children with no voiding dysfunction . During this phase the detrusor contracts, producing voiding detrusor pressure as the bladder outlet relaxes.…”

“…Pressure/flow study (PFS) provides information on voiding function (outflow obstruction, flow pattern, detrusor contractility, and its sustainability as well as intravesical pressure). Combined with filling cystometry, it is the gold standard for evaluating voiding function in children with lower urinary tract dysfunction (LUTD)/lower urinary tract symptoms (LUTS), especially when less invasive studies fail to provide an adequate explanation for the symptoms and/or the signs of dysfunction …”

Bladder function development and its urodynamic evaluation in neonates and infants less than 2 years old

“…It is well known that cooperation is most important for successful UDS. The following steps are recommended to optimize the quality of findings in newborns and infants: Collection of patient history, followed by physical and laboratory examinations of the patient; voiding observation diary. Bowel or rectum preparation just before the study (e.g., by use of a single dosage of a glycerol enema). Appointment of dedicated and knowledgeable staff who are able to educate parents and calm the infant. Implementation of strategies to calm the patient. Parents are allowed to stay, and toys, eating or drinking during the examination is permitted as needed.…”