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Monitoring urinary bladder volume and detecting post-operative urinary retention in children with an ultrasound
L A Rosseland1, G Bentsen, E Hopp
1Department of Anaesthesiology, Rikshospitalet University Hospital, N-0027 Oslo, Norway. l.a.rosseland@medisin.uio.no
Insights
Ultrasound bladder scanning is a reliable, non-invasive method for monitoring urinary bladder volume in children over 3 years old post-surgery. This technique helps prevent over-distension and potential detrusor damage, unlike routine catheterization which risks infection.
Area of Science:
- Pediatric Surgery
- Urology
- Medical Imaging
Background:
- Post-operative urinary retention (PUR) risks detrusor damage; routine catheterization may cause UTIs.
- Current bladder volume monitoring methods are reliable in adults but unevaluated in children.
Purpose of the Study:
- To evaluate the reliability of ultrasound bladder scanning for estimating urinary bladder volume in children.
- To assess if ultrasound monitoring can prevent post-operative urinary retention and its complications in pediatric patients.
Main Methods:
- Forty-eight pediatric patients requiring bladder emptying underwent ultrasound scanning (Bladderscan) before catheterization.
- Ultrasound-estimated volumes were compared to catheter-emptied volumes; fluoroscopy confirmed emptying in 20 children.
Main Results:
- Mean difference between ultrasound and catheter volumes was 4 ml (SD=25 ml) in children >3 years and -18 ml (SD=19 ml) in younger children.
- In children with fluoroscopically confirmed complete emptying (n=14), the mean difference was -11 ml (SD=24 ml).
Conclusions:
- Ultrasound bladder scanning shows agreement with catheter-measured volumes, proving reliable for children over 3 years.
- The technique is a non-invasive, pain-free method to prevent bladder over-distension in pediatric patients post-anesthesia.
Background:
Post-operative urinary retention (PUR) is associated with a risk of over-distension and permanent detrusor damage. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Post-operative monitoring of the bladder volume is a reliable method in adults, but has not been evaluated for reliability in children.
Methods:
Forty-eight patients who, according to current clinical guidelines, required urinary bladder emptying were scanned before catheterization using the Bladderscan. Volumes estimated with ultrasound were compared with volumes measured after emptying the bladder with a catheter. Bladder emptying was controlled by concomitant fluoroscopy in 20 children.
Results:
The mean difference between the ultrasound estimates and the catheter-emptied urine volumes was 4 ml [standard deviation (SD) = 25 ml] in 26 children above the age of 3 years and -18 ml (SD = 19 ml) in 22 younger children. In the subpopulation in whom complete bladder emptying could be confirmed by fluoroscopy (14 children; median age, 3 years; range, 1-11 years), the mean difference between the ultrasound estimates and the catheter-emptied volumes was -11 ml (SD = 24 ml).
Conclusions:
This study confirms agreement between the ultrasound scanner estimates of urinary bladder volume and the urine volume measured by emptying the bladder. Reliability was good in children above the age of 3 years. The volume was underestimated in younger children. Thus, routine monitoring of urinary bladder volume with an ultrasound scanner is a non-invasive, pain-free and reliable way of preventing over-distension of the urinary bladder in children after surgery and other procedures under general anaesthesia.
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