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What is the variability in urodynamic parameters with position change in children? Analysis of a prospectively
Armando J Lorenzo1, M Chad Wallis, Anthony Cook
1Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Insights
Patient position minimally impacts urodynamic parameters in children. However, the sitting position may improve detection of detrusor overactivity and incontinence, making it preferable when tolerated.
Area of Science:
- Pediatric Urology
- Urodynamics
- Clinical Research
Background:
- Urodynamic studies are crucial for diagnosing lower urinary tract dysfunction in children.
- Limited data exist on how patient positioning affects urodynamic outcomes.
Purpose of the Study:
- To investigate the impact of patient position (supine vs. sitting) on urodynamic parameters in pediatric patients.
- To determine the variability of urodynamic measurements between supine and sitting positions.
Main Methods:
- Prospective enrollment of children undergoing urodynamic evaluation.
- Serial urodynamic studies performed consecutively in supine and sitting positions within a single session.
- Standardized infusion volumes and rates across positions.
Main Results:
- No significant differences in maximum cystometric capacity or detrusor leak point pressures between positions.
- Lower volumes for first sensation and detection of detrusor overactivity in the sitting position.
- Increased detection rates for detrusor overactivity and incontinence episodes in the sitting position.
Conclusions:
- Urodynamic studies in children can yield clinically valid results in either supine or sitting positions.
- The sitting position may enhance the detection of detrusor overactivity and incontinence.
- The sitting position is favored if tolerated by the child due to improved diagnostic yield.
Purpose:
Insufficient data are available regarding the effect of patient position on urodynamic parameters and diagnoses in children. We report on a cohort of pediatric patients, comparing the results of serial urodynamic studies to determine the variability between the supine and sitting positions.
Materials And Methods:
Children referred for urodynamic evaluation were prospectively enrolled based on the ability to tolerate position change. Consecutive studies in supine and sitting positions were performed during a single session by the same nursing team. Volume infused and infusion rate did not differ with position change.
Results:
A total of 48 children were enrolled in the study. Mean patient age was 10.4 years. No statistically significant difference was noted for maximum cystometric capacity, detrusor leak point pressures or pressure specific volumes at 20 and 30 cm water between the supine and sitting positions. Statistically significant lower values were found for the volume of first sensation and volume at which detrusor overactivity was first detected (p <0.05), with a trend toward significance for abdominal or Valsalva leak point pressure. Statistically significant differences were also noted with position changes in regard to detection of detrusor overactivity and incontinence episodes (p <0.05).
Conclusions:
In our study population no significant differences were detected in several urodynamic parameters with position change, suggesting that clinically valid conclusions can be obtained by performing the study in either position. Studies in the sitting position allow for increased detection of detrusor overactivity and incontinence, thus, being favored over the supine position if well tolerated by the child.
