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Urodynamic studies in pediatric urology

Nature Reviews Urology volume 6, pages 585–594 (2009)Cite this article

Abstract

In any type of lower urinary tract dysfunction it is mandatory to obtain as much information as possible on the function of the urinary tract. By definition of the International Continence Society, any investigation that produces such information is part of urodynamics. Thus, voiding and defecation history, physical examination, voiding frequency charts and defecation diaries are all essential parts of urodynamics. Repeated free uroflowmetry is considered an essential routine investigation by the International Children's Continence Society. Static and dynamic ultrasonography of the lower urinary tract and the pelvic floor can give important information on lower urinary tract anatomy and function, in a noninvasive manner. Invasive urodynamic studies such as voiding cystourethrography and cystometry are reserved for patients for whom the outcome of such studies is expected to change the therapeutic regime. Invasive urodynamic tests are performed primarily for one of two reasons. First, to confirm an expected diagnosis in new patients. Second, to ensure that the storage pressures in the bladder remain safe for normal functioning of the kidneys in children with chronic disease.

Key Points

  • Any information on the function of the urinary tract is part of urodynamics; a meticulous micturition and defecation history with voiding and defecation diary are invaluable in pediatric patients

  • Invasive urodynamic studies are done to obtain information that directs or changes the treatment of the individual child

  • When diagnosis is done properly, straightforward therapy can be given and the psychological trauma associated with failure to respond to ill-defined treatment strategies can be avoided

  • In patients with chronic lower urinary tract dysfunction of neurogenic origin or after severe obstructive uropathy, invasive urodynamic studies ensure that bladder pressures remain safe, to protect kidney function

  • In a patient with lower urinary tract symptoms, any sign of structural anomalies must be investigated to exclude neurogenic bladder dysfunction

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Figure 1: Diagnosis of children who present with functional lower urinary tract symptoms (LUTS).
Figure 2: A patient with overactive detrusor and urge complaints.
Figure 3: A patient with neurogenic bladder under antimuscarinic treatment.
Figure 4: A patient with an obstructed urethra.
Figure 5: Voiding phase in a girl with dysfunctional voiding.
Figure 6: Voiding phase in a patient with underactive bladder, emptied by straining.
Figure 7: Voiding phase in a patient with underactive bladder, emptied by gravity.

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References

  1. Homma, Y. et al. in Incontinence: 2nd International Consultation on Incontinence, 2001 2nd edn, Ch. 7 (eds Abrams, P. et al.) 317–372 (Health Publications, Plymouth, 2002).

    Google Scholar 

  2. Nevéus, T. et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J. Urol. 176, 314–324 (2006).

    Article  PubMed  Google Scholar 

  3. Tekgul, S. et al. in Incontinence 4th edn (eds Abrams, P. et al.) (Health Publications, Plymouth, 2009).

    Google Scholar 

  4. Rasquin, A. et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130, 1527–1537 (2006).

    Article  PubMed  Google Scholar 

  5. Hyman, P. E. et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 130, 1519–1526 (2006).

    Article  PubMed  Google Scholar 

  6. Mosiello, G. et al. How to investigate neurovesical dysfunction in children with anorectal malformations. J. Urol. 170, 1610–1613 (2003).

    Article  PubMed  Google Scholar 

  7. De Gennaro, M. et al. The incidence of occult spinal dysraphism and the onset of neurovesical dysfunction in children with anorectal anomalies. Eur. J. Pediatr. Surg. 4 (Suppl. 1), 12–14 (1994).

    Article  PubMed  Google Scholar 

  8. De Gennaro, M., Capitanucci, M. L., Mosiello, G., Caione, P. & Silveri, M. The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves. BJU Int. 85, 1104–1108 (2000).

    Article  CAS  PubMed  Google Scholar 

  9. De Gennaro, M. et al. Detrusor hypocontractility in children with posterior urethral valves arises before puberty. Br. J. Urol. 81 (Suppl. 3), 81–85 (1998).

    Article  PubMed  Google Scholar 

  10. Szabo, L., Lombay, B., Borbas, E. & Bajusz, I. Videourodynamics in the diagnosis of urinary tract abnormalities in a single center. Pediatr. Nephrol. 19, 326–331 (2004).

    Article  PubMed  Google Scholar 

  11. Hosker, G. et al. in Incontinence 4th edn (eds Abrams, P. et al.) 585–673 (Health Publications, Plymouth, 2009).

    Google Scholar 

  12. Ural, Z., Ulman, I. & Avanoglu, A. Bladder dynamics and vesicoureteral reflux: factors associated with idiopathic lower urinary tract dysfunction in children. J. Urol. 179, 1564–1567 (2008).

    Article  PubMed  Google Scholar 

  13. Heron, J., Joinson, C., Croudace, T. & von Gontard, A. Trajectories of daytime wetting and soiling in a United Kingdom 4 to 9-year-old population birth cohort study. J. Urol. 179, 1970–1975 (2008).

    Article  PubMed  Google Scholar 

  14. Söderstrom, U., Hoelcke, M., Alenius, L., Söderling, A. C. & Hjern, A. Urinary and fecal incontinence: a population-based study. Acta Paediatr. 93, 386–389 (2004).

    Article  PubMed  Google Scholar 

  15. Dogan, H. S. et al. Non-invasive evaluation of voiding function in asymptomatic primary school children. Pediatr. Nephrol. 23, 1115–1122 (2008).

    Article  PubMed  Google Scholar 

  16. Yeung, C. K., Sreedhar, B., Leung, Y. F. & Sit, K. Y. Correlation between ultrasonographic bladder measurements and urodynamic findings in children with recurrent urinary tract infection. BJU Int. 99, 651–655 (2007).

    Article  PubMed  Google Scholar 

  17. Yeung, C. K., Sreedhar, B., Leung, V. T. & Metreweli, C. Ultrasound bladder measurements in patients with primary nocturnal enuresis: a urodynamic and treatment outcome correlation. J. Urol. 171, 2589–2594 (2004).

    Article  CAS  PubMed  Google Scholar 

  18. Klijn, A. J., Asselman, M., Vijverberg, M. A., Dik, P. & de Jong, T. P. The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding. J. Urol. 172, 1986–1988 (2004).

    Article  PubMed  Google Scholar 

  19. Joensson, I. M., Siggaard, C., Rittig, S., Hagstroem, S. & Djurhuus, J. C. Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J. Urol. 179, 1997–2002 (2008).

    Article  PubMed  Google Scholar 

  20. de Jong, T. P. et al. Effect of biofeedback training on paradoxical pelvic floor movement in children with dysfunctional voiding. Urology 70, 790–793 (2007).

    Article  PubMed  Google Scholar 

  21. de Jong, T. P., Klijn, A. J., Vijverberg, M. A. & de Kort, L. M. Ultrasound imaging of sacral reflexes. Urology 68, 652–654 (2006).

    Article  PubMed  Google Scholar 

  22. de Kort, L. M., Verhulst, J. A., Engelbert, R. H., Uiterwaal, C. S. & de Jong, T. P. Lower urinary tract dysfunction in children with generalized hypermobility of joints. J. Urol. 170, 1971–1974 (2003).

    Article  PubMed  Google Scholar 

  23. Abrams, P. et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol. Urodyn. 21, 167–178 (2002).

    Article  PubMed  Google Scholar 

  24. Schober, J. M., Dulabon, L. M. & Woodhouse, C. R. Outcome of valve ablation in late-presenting posterior urethral valves. BJU Int. 94, 616–619 (2004).

    Article  PubMed  Google Scholar 

  25. de Jong, T. P. et al. Posterior urethral valves: search for a diagnostic reference standard. Urology 72, 1022–1025 (2008).

    Article  PubMed  Google Scholar 

  26. de Kort, L. M. et al. Reliability of voiding cystourethrography to detect urethral obstruction in boys. Urology 63, 967–971 (2004).

    Article  PubMed  Google Scholar 

  27. de Kort, L. M., Klijn, A. J., Dik, P., Uiterwaal, C. S. & de Jong, T. P. Oxybutynin for diagnosis of infravesical obstruction in boys with urinary incontinence. Urology 62, 127–130 (2003).

    Article  PubMed  Google Scholar 

  28. Hoebeke, P., Van Laecke, E., Raes, A., van Gool, J. D. & Vande Walle, J. Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction. BJU Int. 83, 294–298 (1999).

    Article  CAS  PubMed  Google Scholar 

  29. Klijn, A. J. et al. Home uroflowmetry biofeedback in behavioral training for dysfunctional voiding in school-age children: a randomized controlled study. J. Urol. 175, 2263–2268 (2006).

    Article  PubMed  Google Scholar 

  30. Hinman, F. & Baumann, F. W. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J. Urol. 109, 727–732 (1973).

    Article  CAS  PubMed  Google Scholar 

  31. Sherman, N. D., Stock, J. A. & Hanna, M. K. Bladder dysfunction after bilateral ectopic ureterocele repair. J. Urol. 170, 1975–1977 (2003).

    Article  PubMed  Google Scholar 

  32. Abrahamsson, K., Hansson, E., Sillen, U., Hermansson, G. & Hjalmas, K. Bladder dysfunction: an integral part of the ectopic ureterocele complex. J. Urol. 160, 1468–1470 (1998).

    Article  CAS  PubMed  Google Scholar 

  33. Beganovic, A., Klijn, A. J., Dik, P. & de Jong, T. P. Ectopic ureterocele: long-term results of open surgical therapy in 54 patients. J. Urol. 178, 251–254 (2007).

    Article  PubMed  Google Scholar 

  34. Bauer, S. B. et al. Predictive value of urodynamic evaluation in newborns with myelodysplasia. JAMA 252, 650–652 (1984).

    Article  CAS  PubMed  Google Scholar 

  35. Dik, P., Klijn, A. J., van Gool, J. D., de Jong–de Vos van Steenwijk, C. C. & de Jong, T. P. Early start to therapy preserves kidney function in spina bifida patients. Eur. Urol. 49, 908–913 (2006).

    Article  PubMed  Google Scholar 

  36. de Jong, T. P., Chrzan, R., Klijn, A. J. & Dik, P. Treatment of the neurogenic bladder in spina bifida. Pediatr. Nephrol. 23, 889–896 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ozel, S. K., Dokumcu, Z., Akyildiz, C., Avanoglu, A. & Ulman, I. Factors affecting renal scar development in children with spina bifida. Urol. Int. 79, 133–136 (2007).

    Article  CAS  PubMed  Google Scholar 

  38. De Gennaro, M., Capitanucci, M. L., Silveri, M., Morini, F. A. & Mosiello, G. Detrusor hypocontractility evolution in boys with posterior urethral valves detected by pressure flow analysis. J. Urol. 165, 2248–2252 (2001).

    Article  CAS  PubMed  Google Scholar 

  39. Koff, S. A., Mutabagani, K. H. & Jayanthi, V. R. The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. J. Urol. 167, 291–297 (2002).

    Article  PubMed  Google Scholar 

  40. de Kort, L. M., Klijn, A. J., Uiterwaal, C. S. & de Jong, T. P. Ureteral reimplantation in infants and children: effect on bladder function. J. Urol. 167, 285–287 (2002).

    Article  PubMed  Google Scholar 

  41. Hoebeke, P., Van, L. E., Van, C. C., Raes, A. & Van De Walle, J. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int. 87, 575–580 (2001).

    Article  CAS  PubMed  Google Scholar 

  42. Schafer, W. et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol. Urodyn. 21, 261–274 (2002).

    Article  PubMed  Google Scholar 

  43. Luijt, D. S., Schirm, J., Savelkoul, P. H. & Hoekstra, A. Risk of infection by reprocessed and resterilized virus-contaminated catheters: an in vitro study. Eur. Heart J. 22, 378–384 (2001).

    Article  CAS  PubMed  Google Scholar 

  44. Ishino, Y., Ido, K. & Sugano, K. Contamination with hepatitis B virus DNA in gastrointestinal endoscope channels: risk of infection on reuse after on-site cleaning. Endoscopy 37, 548–551 (2005).

    Article  CAS  PubMed  Google Scholar 

  45. Sozubir, S., Celik, A., Emir, N., Avanoglu, A. & Ulman, I. Consistency of urodynamic parameters in children with detrusor instability: how many times should the bladder be filled? Urol. Int. 75, 129–132 (2005).

    Article  PubMed  Google Scholar 

  46. Koff, S. A. Estimating bladder capacity in children. Urology 21, 248 (1983).

    Article  CAS  PubMed  Google Scholar 

  47. Berger, R. M., Maizels, M., Moran, G. C., Conway, J. J. & Firlit, C. F. Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns. J. Urol. 129, 347–349 (1983).

    Article  CAS  PubMed  Google Scholar 

  48. Wahl, E. F. & Churchill, B. M. Detrusor pressure rise in a normal bladder. BJU Int. 94, 901–902 (2004).

    Article  PubMed  Google Scholar 

  49. Wahl, E. F., Lerman, S. E., Lahdes-Vasama, T. T. & Churchill, B. M. Measurement of bladder compliance can be standardized by a dimensionless number: clinical perspective. BJU Int. 94, 898–900 (2004).

    Article  PubMed  Google Scholar 

  50. Ghobish, A. G. Storage detrusor pressure in bilateral hydroureteronephrosis. Eur. Urol. 39, 571–574 (2001).

    Article  CAS  PubMed  Google Scholar 

  51. Vereecken, R. L. & Proesmans, W. Urethral instability as an important element of dysfunctional voiding. J. Urol. 163, 585–588 (2000).

    Article  CAS  PubMed  Google Scholar 

  52. McCormack, M., Pike, J. & Kiruluta, G. Leak point of incontinence: a measure of the interaction between outlet resistance and bladder capacity. J. Urol. 150, 162–164 (1993).

    Article  CAS  PubMed  Google Scholar 

  53. Vanderbrink, B. A., Gitlin, J. & Palmer, L. S. Uroflowmetry parameters before and after meatoplasty for primary symptomatic meatal stenosis in children. J. Urol. 179, 2403–2406 (2008).

    Article  PubMed  Google Scholar 

  54. Farhane, S. et al. Uroflowmetry in children: prospective study of normal parameters [French]. Prog. Urol. 16, 598–601 (2006).

    PubMed  Google Scholar 

  55. Szabo, L. & Fegyverneki, S. Maximum and average urine flow rates in normal children—the Miskolc nomograms. Br. J. Urol. 76, 16–20 (1995).

    Article  CAS  PubMed  Google Scholar 

  56. Wese, F. X. et al. Body surface related flow rate nomograms in a normal pediatric population. Acta Urol. Belg. 57, 467–474 (1989).

    CAS  PubMed  Google Scholar 

  57. Schmidt, F., Jorgensen, T. M. & Djurhuus, J. C. Twenty-four-hour ambulatory urodynamics in healthy young men. Scand. J. Urol. Nephrol. 215 (Suppl.), 75–83 (2004).

    Article  Google Scholar 

  58. Schmidt, F., Shin, P., Jorgensen, T. M., Djurhuus, J. C. & Constantinou, C. E. Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function. J. Urol. 168, 1458–1463 (2002).

    Article  PubMed  Google Scholar 

  59. Defreitas, G. A., Zimmern, P. E., Lemack, G. E. & Shariat, S. F. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology 64, 675–679 (2004).

    Article  PubMed  Google Scholar 

  60. Sillén, U. Bladder function in infants. Scand. J. Urol. Nephrol. 215 (Suppl.), 69–74 (2004).

    Article  Google Scholar 

  61. Yeung, C. K. et al. Some new insights into bladder function in infancy. Br. J. Urol. 76, 235–240 (1995).

    Article  CAS  PubMed  Google Scholar 

  62. Halachmi, S. The molecular pathways behind bladder stretch injury. J. Pediatr. Urol. 5, 13–16 (2009).

    Article  PubMed  Google Scholar 

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Pediatric Urology, University Children's Hospitals, University Medical Center, Utrecht and Academic Medical Center, Amsterdam, The Netherlands

    Tom P. V. M. de Jong & Aart J. Klijn

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Correspondence to Tom P. V. M. de Jong.

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de Jong, T., Klijn, A. Urodynamic studies in pediatric urology. Nat Rev Urol 6, 585–594 (2009). https://doi.org/10.1038/nrurol.2009.200

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