The reliability of cysto‐urethrographic signs in the diagnosis of detrusor instability in children

Abstract

Objective To assess whether the signs associated with specific signs (only vesico-ureteric reflux or vaginal voiding) in 25 (49%) of patients, whereas 26 (51%) detrusor instability (DI), as assessed by videourodynamic studies, can be evaluated by conventional had some signs suspicious of DI. Suspicious signs were urethral ballooning (in 11), bladder trabeculation or voiding cysto-urethrography (VCUG). Patients and methods Fifty-nine children who under-a constricting ring (eight), a 'spinning-top' urethra (three), urethral notching (two) and Mercier's bar went cystometry and VCUG were reviewed and divided into two groups; group 1 comprised 51 neurologically (one). In group 2, five patients had no abnormal findings on VCUG and three had suspicious signs. The normal children who had DI (47 girls and four boys, mean age 7.9 years, range 4-14), with no malfor-positive predictive value of VCUG was high (0.89) but the diagnostic yield of suspicious signs was low, mations or previous surgery. Most had mixed symptoms, including urinary tract infections (44) and because the sensitivity (0.5), specificity (0.62) and overall accuracy (0.52) were low. nocturnal enuresis with daytime symptoms (20); group 2 (control) comprised eight children (seven girls, Conclusion Radiological signs suspicious of DI cannot be regarded as such in conventional VCUG, as mean age 9.7 years, range 6-15) with a stable bladder and the same clinical presentation. The interval although they were detected in half the patients with DI, they also occurred in three of eight children with between VCUG and cystometry ranged from 1 day to 5 months (mean 47 days) and was similar in both a stable bladder. Keywords Bladder instability, children, voiding cysto-groups. Signs considered suspicious of DI were sought in the findings of VCUG.urethrography Results In group 1, VCUG was normal or showed no

The risk factors for recurrence of febrile urinary tract infection and renal scarring in children with functional urinary incontinence

“…31 Several studies considered a compliance lower than 10 mL/cm H 2 O as low bladder compliance. 32,33 In this study, we determined that 39.3% of the patients Dysfunctional voiding is a dysmotility of lower urinary tract disorders which is characterized by bladder outlet obstruction because of dyssynergic external sphincteric activity during voiding without neurological problems and structural disease. 34 Dysfunctional voiding causes detrusor hypertrophy, increased postvoid residual, and raised intravesical pressure during filling.…”

Role of spinning top urethra in dysfunctional voiding

“…All categorical variables for the two groups are shown in Table I. There were 84 children (mean age 8.3 ± 2.2 years, range [4][5][6][7][8][9][10][11][12][13][14] in group I and 70 (mean age 8.0 ± 2.1 years, range [4][5][6][7][8][9][10][11][12][13][14] in group II, and no significant age difference was found between the two groups (p = 0.4674). Group I consisted of 66 (71%) girls and 18 (29%) boys and group II 44 (63%) girls and 26 (37%) boys.…”

“…Of the 154 children with emptying phase disorder 110 (71%) were girls and 44 (29%) were boys. Mean patient age at referral was 8 years (range [4][5][6][7][8][9][10][11][12][13][14]. A thorough history, physical examination, urinalysis, urine culture, voiding diary and upper urinary tract ultrasonography had been performed in all cases.…”

“…To provide simultaneous anatomical and functional information, cystometry was combined with intermittent fluoroscopy, thus constituting the VUD observation. Detrusor overactivity was defined as the presence of phasic uninhibited detrusor contractions during cystometry and considered pathological if the detrusor pressure was more than 15 cmH 2 O [11]. Bladder compliance was defined as the volume at capacity divided by detrusor pressure at that volume.…”

“…Bladder compliance was defined as the volume at capacity divided by detrusor pressure at that volume. Diminished bladder compliance was considered to be < 10 ml/cmH 2 O [11]. After urodynamic observations were recorded, all cases were reviewed with respect to STU and VUR, provided by fluoroscopic evidence.…”