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Published on: January 11, 2016
Correlation between motor function and lower urinary tract dysfunction in patients with infantile cerebral palsy
Stephan Bross1, Patrick Honeck, Sun Tscheol Kwon
1Department of Urology, University Hospital Mannheim, 68135 Mannheim, Germany. sbross@gmx.de
Insights
Urinary symptoms and abnormal urodynamic findings in children with cerebral palsy (CP) worsen with greater motor impairment. Pathological urodynamic results are present in both symptomatic and asymptomatic individuals.
Area of Science:
- Urology
- Neurology
- Pediatrics
Background:
- Infantile cerebral palsy (CP) often presents with complex neurogenic bladder dysfunction.
- Understanding the relationship between motor impairment and urodynamic findings is crucial for patient management.
Purpose of the Study:
- To evaluate urodynamic findings in patients with infantile cerebral palsy (CP).
- To correlate these findings with the degree of motor function impairment using the Gross Motor Function Classification System for CP (GMFCS).
Main Methods:
- Videourodynamic investigation was performed on 29 patients (3-53 years) with CP.
- Patients were classified using the GMFCS, ranging from Level I (most independent) to Level V (least independent).
- Patients were divided into symptomatic (Group 1) and asymptomatic (Group 2) groups.
Main Results:
- Symptomatic patients (Group 1) frequently exhibited reduced bladder compliance (91%) and increased detrusor leak point pressure (DLPP) (70%).
- Detrusor and pelvic floor overactivity were observed in all symptomatic patients (100%) and 83% of asymptomatic patients.
- Symptomatic patients generally had higher GMFCS levels compared to asymptomatic patients, who were not classified in the highest impairment levels (IV or V).
Conclusions:
- Urinary symptoms and abnormal urodynamic findings correlate with the severity of motor function impairment in CP patients as defined by GMFCS.
- Pathological urodynamic findings are not exclusive to symptomatic individuals and can be present in asymptomatic CP patients.
Aims:
The aim of this study was to evaluate urodynamic findings in patients with infantile cerebral palsy (CP) and to correlate the findings with impaired motor function.
Methods:
We conducted a videourodynamic investigation on a highly select group of 29 patients (3-53 years). Motor function was assessed in each patient by the Gross Motor Function Classification System for CP (GMFCS). With this system, motor function is divided into five levels: patients in Level I have the most independent motor function and patients in Level V the least. The patients were divided into Group 1 (23 symptomatic patients with recurrent urinary tract infection or urinary incontinence) and Group 2 (6 asymptomatic patients).
Results:
In Group 1, 21 patients (91%) had reduced compliance (0.6-16.4 ml/cmH(2)O) and 16 patients (70%) had increased DLPP (>40 cmH(2)O). Detrusor overactivity and pelvic floor overactivity were found in all 23 patients. In Group 2, two patients (33%) had reduced compliance (0.7 and 5.8 ml/cmH(2)O) and four (67%) had increased DLPP (>40 cm H(2)O). Detrusor overactivity and pelvic floor overactivity were observed in five patients (83%). Symptomatic patients showed higher GMFCS levels than asymptomatic patients. In the group of asymptomatic patients, there was no one classified as Levels IV or V, while there were no symptomatic patients classified as Level I.
Conclusions:
We conclude that urinary symptoms and pathological urodynamic findings increase along with the degree of motor function impairment shown by the GMFCS. Pathologic urodynamic findings can be found in both symptomatic and in asymptomatic patients.
