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Recognition of bladder instability on voiding cystourethrography in infants with urinary tract infection
M Bachelard1, G Verkauskas, M Bertilsson
1Department of Pediatric Radiology, The Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden.
Insights
Voiding cystourethrography can identify bladder instability in infants using specific radiological signs. Increased signs correlate with more accurate detection of unstable detrusor contractions.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Radiology
Background:
- Infant urinary tract infections (UTIs) can be associated with bladder dysfunction.
- Accurate diagnosis of bladder instability in infants is crucial for appropriate management.
Purpose of the Study:
- To evaluate voiding cystourethrography (VCUG) as a diagnostic tool for identifying bladder instability in infants.
- To correlate radiological signs observed during VCUG with urodynamic findings.
Main Methods:
- VCUG combined with cystometry in 143 infants (79 male, 64 female) with first-time UTIs.
- Radiological signs (bladder wall irregularity, shape elongation, posterior urethra filling) assessed during bladder filling.
- Correlation of radiological signs with simultaneous detrusor pressure recordings.
Main Results:
- VCUG demonstrated 90% sensitivity and specificity for detecting bladder instability.
- Accuracy increased with the number of observed radiological signs (29% with 1 sign, 91% with 3 signs).
- Urologist and radiologist evaluations showed comparable, reliable results.
Conclusions:
- Radiological signs on VCUG effectively identify unstable detrusor contractions in infants.
- Bladder wall irregularity, shape elongation, and posterior urethra filling are indicative of instability.
- The presence of multiple signs strengthens the indication of bladder instability.
Purpose:
We evaluate voiding cystourethrography as a method for identifying bladder instability in infants.
Materials And Methods:
Cystometry was combined with voiding cystourethrography in 79 male and 64 female infants with first time urinary tract infection. Bladder wall irregularity, elongation of bladder shape, and filling of the posterior urethra were transient radiological signs occurring during bladder filling and were considered to reflect bladder instability. A pediatric radiologist looked for these signs on all 480 films exposed during bladder filling. The results were correlated to simultaneous detrusor pressure recordings. The analysis was repeated independently by a urologist to evaluate the reliability of the radiological signs used.
Results:
The sensitivity and specificity were both 90% in the evaluation of radiological signs of bladder instability. Filling of the posterior urethra was the least frequently reported radiological sign, which was seen at 53% of unstable contractions. However, when this sign was reported, instability was usually correctly detected (85%). Evaluation accuracy had improved with increasing numbers of noted signs per film. This accuracy had included 29%, 67% and 91% of unstable contractions that were correctly diagnosed when 1, 2 or 3 signs were noted, respectively. The number of noted signs was positively related to the strength of the unstable detrusor contraction. Urologist evaluations had similar results to the radiologist, although the sensitivity was somewhat lower (79% and 90%, respectively).
Conclusions:
Unstable detrusor contractions could be identified in infants by evaluation of radiological signs on voiding cystourethrography. Findings of bladder wall irregularity, elongation of bladder shape and filling of the posterior urethra indicated unstable detrusor contraction. The more such findings are observed, the stronger the indication.