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Published on: August 14, 2019
Correlation between ultrasonographic bladder measurements and urodynamic findings in children with recurrent urinary
Chung-Kwong Yeung1, Biji Sreedhar, Yee-Fong V Leung
1Division of Paediatric Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. ckyeung@surgery.cuhk.edu.hk
Insights
Ultrasonography (US) measurements of bladder volume and wall thickness index (BVWI) effectively identify bladder dysfunction in children with urinary tract infections (UTIs). This non-invasive method reliably predicts overactive or hypocontractile bladder patterns, guiding further diagnostic steps.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Urinary tract infections (UTIs) in children can lead to significant bladder dysfunction.
- Accurate assessment of bladder function is crucial for effective management.
- Ultrasonography (US) offers a non-invasive method for evaluating bladder characteristics.
Purpose of the Study:
- To assess the utility of bladder variables measured by ultrasonography (US) in diagnosing bladder dysfunction in pediatric patients with urinary tract infections (UTIs).
- To correlate ultrasonographic findings with urodynamic patterns.
- To determine if US can serve as a reliable indicator for further invasive urodynamic studies.
Main Methods:
- Prospective recruitment of children with recurrent UTIs.
- Performance of ultrasonography (US) and both natural-filling cystometry (NFC) and conventional-filling cystometry (CFC) at study entry.
- Calculation of bladder volume and wall thickness index (BVWI) and classification into 'thick' (<70), 'normal' (70-130), and 'thin' (>130) based on US findings; correlation with urodynamic patterns (normal, overactive, hypocontractile).
Main Results:
- Out of 61 children, 36 had a 'thick' BVWI, 16 normal, and 9 'thin'.
- A 'thick' BVWI (<70) strongly correlated with overactive bladder (92%, P < 0.001), while a 'thin' BVWI (>130) was associated with hypocontractile patterns (6/9 children).
- Children with 'thick' bladders showed significantly reduced bladder capacity (56.7% of expected) and higher voiding detrusor pressure compared to those with normal or thin bladders (P < 0.001).
Conclusions:
- The bladder volume and wall thickness index (BVWI) measured by ultrasonography (US) is a sensitive diagnostic tool for bladder dysfunction in children with UTIs.
- US-derived BVWI reliably predicts urodynamic patterns, including overactive and hypocontractile bladders.
- This non-invasive ultrasonographic assessment serves as a valuable guide for selecting appropriate, potentially invasive, urodynamic studies.
Objective:
To evaluate the role of bladder variables measured by ultrasonography (US) in assessing bladder dysfunction in children with urinary tract infections (UTIs).
Patients And Methods:
Children presenting with recurrent UTI (with or with no vesico-ureteric reflux) were prospectively recruited. At entry, each patient had US and both natural- filling (NFC) and conventional-filling (CFC) cystometry. Bladder volume and wall thickness index (BVWI) was calculated, and based on US studies and the bladder pattern on US, were classified as thick (BVWI <70), normal (70-130) and thin (>130) as previously reported. The criteria for diagnosing urodynamic patterns included normal, overactive and hypocontractile, as reported previously. The correlation between the US measured variables and urodynamic findings were then evaluated. Sixty-one children (38 boys and 23 girls; mean age 4.82 years, range 1-11) were selected for further evaluation.
Results:
Of the 61 children, 16 had a normal BVWI, 36 a 'thick' value and nine 'thin'. When the BVWI was correlated with the urodynamic findings, 14 of 16 with a normal BVWI had a normal bladder pattern, whereas 92% of the patients with a BVWI of <70 had overactive bladder (P < 0.001). Among children with a BVWI of >130, six of nine had a hypocontractile pattern. The mean (sd) bladder capacity (on CFC) compared to that expected for age was significantly lower, at 56.7 (32.3)% in 'thick' bladders, vs children with normal and thin bladders, at 91.3 (23.8)% and 98.7 (31.8)%, respectively (P < 0.001). A high voiding detrusor pressure was significantly associated with children who had a thick bladder rather than normal or thin bladder (P < 0.001).
Conclusions:
This study further confirmed that the BVWI is a sensitive tool for diagnosing bladder dysfunction in children, and it can be used as a reliable guide for the appropriate choice of further invasive urodynamic studies.
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