Lower urinary tract dysfunction in children with cerebral palsy

The focus of this study was to evaluate urodynamic findings and possible renal damage in children with cerebral palsy and urinary symptoms.

Children with cerebral palsy and lower urinary tract symptoms were studied. Patients were submitted to urodynamic evaluation, urine examination, measurement of serum creatinine, and renal and urinary tract ultrasonography. Voiding cystourethrography was performed on patients with urinary tract infections.

Thirty-seven children were investigated, including 21 females and 16 males. The mean age was 7 years and 8 months [SD of 4 years 6 months], with a range from 1 to 17-year-old. The symptoms that led to evaluation were urinary infections in 21 56.7% cases, incontinence in 15 (40.5%) cases, increased voiding frequency in six (16%) cases, enuresis in five (13.5%) cases, and hesitancy and urgency in two (5.4%) cases each. The urodynamic findings involved reduced bladder capacity in 20 (54%) cases, with mean cystometric capacity of 168.0 +/- 122.2 ml. Detrusor overactivity was observed in 13 (35.1%) cases, with mean of 67.9 +/- 34.6 cmH(2)O. The range of the residual volume was 17.5 +/- 33.5 ml, which was increased in five (13.5%) cases. Low bladder compliance was seen in four (10.8%) patients, mean bladder compliance of 22.2 +/- 12.2 ml/cmH(2)O. No hydronephrosis or reflux was observed.

Almost one-third of the patients with cerebral palsy and urinary symptoms presented with normal urodynamic findings. The most frequent findings were reduced bladder capacity, detrusor overactivity, and increased post-void residual. No urinary tract complications were observed.