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Published on: August 9, 2012
Home bladder pressure measurements correlate with urodynamic storage pressures and high-grade hydronephrosis in
Kathy H Huen1, Joshua D Chamberlin2, Amanda Macaraeg1
1Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA.
Insights
Home bladder pressure monitoring can identify spina bifida patients at risk for kidney damage. Elevated home bladder pressure measurements accurately predict high storage pressures during urodynamics and hydronephrosis, enabling early intervention.
Area of Science:
- Urology
- Pediatric Nephrology
- Biomedical Engineering
Background:
- Spina bifida patients face risks of bladder and kidney deterioration due to elevated bladder storage pressures.
- Neurogenic bladder in spina bifida requires careful management to prevent upper urinary tract damage.
Purpose of the Study:
- To assess the correlation between home bladder pressure and volume measurements (home manometry) and urodynamic (UDS) detrusor storage pressures.
- To determine the association of home manometry with the presence of Society of Fetal Urology (SFU) grades 3-4 hydronephrosis.
- To evaluate home manometry as a tool for monitoring patients with spina bifida and neurogenic bladder.
Main Methods:
- Prospective data collection from 52 spina bifida patients with neurogenic bladder undergoing clean intermittent catheterization.
- Patients performed home bladder pressure and volume measurements using standard catheterization equipment and a ruler.
- Home measurements were compared to UDS detrusor pressures and SFU hydronephrosis grades, with receiver-operator characteristic curves used for analysis.
Main Results:
- Three home manometry metrics (maximum bladder pressure, pressure at maximum catheterized volume, mean bladder pressure) >20 cm H2O were sensitive indicators for elevated UDS detrusor pressures (>20 cm H2O at 50% maximal cystometric capacity).
- Maximal home bladder pressure >20 cm H2O demonstrated high sensitivity (100%) and specificity (70%) for predicting elevated UDS pressures (AUC 0.92) and high sensitivity (100%) for SFU grades 3-4 hydronephrosis (AUC 0.89).
- No patients with maximal home bladder pressure <20 cm H2O exhibited SFU grades 3-4 hydronephrosis.
Conclusions:
- Home manometry is a sensitive, inexpensive, and simple method for identifying spina bifida patients at risk for upper tract dilation.
- Maximal home bladder pressure <20 cm H2O effectively rules out the presence of significant hydronephrosis (SFU grades 3-4).
- Home manometry facilitates monitoring of high-risk individuals, potentially preventing costly and morbid upper tract damage.
Background:
Patients with spina bifida are at risk for developing bladder and renal deterioration secondary to increased bladder storage pressures.
Objectives:
To determine the association of home bladder volume and pressure measurements (home manometry) to: 1) detrusor storage pressures on urodynamics (UDS); and 2) the presence of Society of Fetal Urology (SFU) grades 3-4 hydronephrosis on renal bladder ultrasound in patients with spina bifida.
Methods:
Data were prospectively collected on patients with spina bifida and neurogenic bladder requiring clean intermittent catheterization. Patients used a ruler and typical catheterization equipment to measure bladder pressures and volumes at home. Home measurements were compared to UDS detrusor pressures and SFU hydronephrosis grade. Detrusor pressure <20 cm H2O at 50% maximal cystometric capacity (MCC) on UDS was used as a measure of safe storage pressures on UDS; conversely, detrusor pressure >20 cm H2O was used a measure to capture both unsafe storage pressures and those with potential for unsafe storage pressures. Receiver-operator characteristic curves and area under curve (AUC) were calculated to depict the association between home manometry variables with detrusor pressures on UDS and SFU grades 3-4 hydronephrosis.
Results:
Included were 52 patients with a median age of 10.3 years (interquartile range 6.3-14.4 years). Three home manometry measurements (maximum bladder pressure, bladder pressure at maximum catheterized volume, and mean bladder pressure) > 20 cm H2O were sensitive for Pdet >20 cm H2O at 50% MCC. Maximal bladder pressure >20 cm H2O was the most sensitive among home manometry measures (sensitivity 100%, specificity 70%, AUC 0.92 for Pdet >20 cm H2O at 50% MCC on UDS; sensitivity 100%, specificity 62%, AUC 0.89 for SFU grade 3-4 hydronephrosis). None of the patients who had maximum home bladder pressure <20 cm H2O had SFU grades 3-4 hydronephrosis; conversely, individuals with maximal home bladder pressure >20 cm had a wide range of hydronephrosis grades.
Conclusion:
None of the patients with maximal home bladder pressure <20 cm H2O had grade 3-4 hydronephrosis. Home measurements of maximal bladder pressure, bladder pressure at maximum catheterized volume and mean bladder pressure of >20 cm H2O were all sensitive for Pdet >20 cm H2O at 50% MCC on UDS. Home manometry is an inexpensive and simple technique to identify patients at risk for and to monitor individuals at high risk of upper tract dilation, without incurring significant cost or morbidity.
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