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Trying to predict 'dangerous' bladders in children: the area under the curve concept
H Hashim1, J Ellis-Jones, L Swithinbank
1Bristol Urological Institute, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK. hashim@doctors.org.uk
Insights
This study explored using the area under the detrusor pressure curve (AUC) to identify dangerous bladders in children undergoing urodynamics. No correlation was found, likely due to software limitations, highlighting the need for standardized methods.
Area of Science:
- Pediatric Urology
- Urodynamics
- Lower Urinary Tract Dysfunction
Background:
- Video urodynamics is standard for diagnosing lower urinary tract dysfunction in children.
- Current methods for predicting 'dangerous' bladders, like bladder compliance, lack standardization in pediatric populations.
- Detrusor overactivity waves can occur even with normal bladder compliance.
Purpose of the Study:
- To investigate if the area under the detrusor pressure curve (AUC) during urodynamics filling is a useful predictor of 'dangerous' bladders in children.
- To address the lack of standardized methods for predicting dangerous bladders in pediatric urodynamics.
Main Methods:
- Retrospective analysis of raw urodynamics data from 15 children referred to a tertiary center between 2000-2004.
- Assessment of the area under the detrusor pressure curve (AUC) using available computer software.
Main Results:
- No significant correlation was found between the AUC and the prediction of 'dangerous' bladders.
- Limitations in the computer software's ability to accurately determine AUC were identified as a potential confounding factor.
Conclusions:
- The study did not establish AUC as a predictor of 'dangerous' bladders in this cohort.
- Significant limitations in current software for AUC calculation necessitate the development of standardized tools.
- Multinational, multi-center trials and standardization by the International Continence Society are recommended for future research.
Objective:
Children with neurological and non-neurological lower urinary tract dysfunction normally undergo video urodynamics. One reason is to try to diagnose 'dangerous' bladders. Currently, bladder compliance is used to predict 'dangerous' bladders; however, in children there are no standardized methods of measurement and thus no 'cut-off' values. Compliance may also be normal even though high-pressure detrusor overactivity waves may exist during the filling phase of urodynamics. We tried to determine whether measuring the area under the detrusor pressure curve (AUC) during the filling phase of urodynamics would be a useful parameter in predicting 'dangerous' bladders.
Patients And Methods:
Children referred to the urodynamics unit at Southmead Hospital, a tertiary referral centre, from 2000 to 2004 were investigated. Although 130 patients were identified, only 15 patients had raw data which were analysable using the available computer software.
Results:
There was no correlation between the AUC and predicting 'dangerous' bladders possibly due to limitations in the computer software.
Conclusion:
Although the study did not reveal any correlation between the AUC and 'dangerous' bladders, it revealed the limitations of the available computer software in determining AUC, and highlighted the need for new standardized software and multinational, multi-centre trials to look into the concept of AUC. There is also a need for the International Continence Society to standardize methods and terminology in predicting 'dangerous' bladders.
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