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Evaluation of a non-invasive bladder volume measurement in children
Erik Koomen1, Esther Bouman, Piet Callewaerdt
1Department of Anaesthesia, Sophia Children's Hospital, Rotterdam, The Netherlands. e.koomen@erasmusmc.nl
Insights
Ultrasound monitoring of bladder volume in children showed poor agreement with actual volumes, underestimating bladder fullness. This pediatric ultrasound device is not recommended to replace current clinical assessment for preventing postoperative urinary retention.
Area of Science:
- Pediatric urology
- Medical device evaluation
- Diagnostic imaging
Background:
- Postoperative urinary retention (PUR) is a risk after surgery, potentially managed by catheterization, which carries infection risks.
- Ultrasound bladder volume monitoring is reliable in adults but unproven in children for PUR prevention.
Purpose of the Study:
- To evaluate the accuracy of the BladderScan BVI 6200 ultrasound device for measuring bladder volume in pediatric patients.
- To determine if this device can reliably prevent postoperative urinary retention in children.
Main Methods:
- A blinded calibration study involving 40 pediatric patients requiring urinary catheterization.
- Ultrasound bladder volume assessment before and after catheterization, with comparison to measured drainage or injected fluid volumes (0, 2.5, 5 ml/kg).
Main Results:
- Significant differences were found between ultrasound-estimated and actual bladder volumes (p = 0.001).
- The mean relative difference (bias) was -20%, with a wide 95% confidence interval (-140% to 180%).
- Bladder volumes below 5 ml/kg were consistently underestimated.
Conclusions:
- The BladderScan BVI 6200 showed poor agreement for bladder volumes below 5 ml/kg in children.
- The device's underestimation and broad confidence intervals suggest it should not replace current clinical assessments for PUR prevention in pediatric patients.
Objective:
Postoperative urinary retention (PUR) is associated with overdistension of the bladder. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Postoperative monitoring of the bladder volume by ultrasound to prevent PUR is reliable in adults, but has not been evaluated in children.
Material And Methods:
The BladderScan BVI 6200, an ultrasound device specifically designed for children, was assessed. Forty patients who required urinary catheter placement during surgery or during intensive care unit stay were entered into this blinded calibration study. An assessment of bladder urine volume by ultrasound was performed before and after catheterization in surgical patients. In these patients and intensive care patients 0, 2.5 or 5 ml/kg sterile normal NaCl was injected through the bladder catheter and the catheter was clamped. Volumes estimated with ultrasound were compared with measured catheter drainage or/and injected volume after the scan.
Results:
The mean relative difference (bias) between the ultrasound estimate and the injected volume was -20% (95% confidence interval 140 to -180%). Precision, estimated using the Wilcoxon signed ranks test, showed a significant difference (Z = -3.25, p = 0.001) between the ultrasound-estimated volumes and the injected volumes.
Conclusions:
This study could not confirm good agreement between the ultrasound-estimated volumes and the injected volumes at volumes below 5 ml/kg. Bladder volumes were underestimated with a very broad 95% confidence interval. The ultrasound device should not replace current clinical assessment.
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