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Determination of voiding pressure in infants with normal lower urinary tracts: Exploring the possible effect of
Mazyar Zahir1,2, Seyedeh-Sanam Ladi-Seyedian1,3, Masoumeh Majidi Zolbin1
1Department of Pediatric Urology, Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Institute, Children's Hospital Medical Center, Pediatrics' Center of excellence, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Infants with sacral underdevelopment, indicated by a low sacral ratio (SR), have significantly higher maximum detrusor voiding pressure (P det. Max). This finding suggests a link between sacral development and bladder function in infants.
Area of Science:
- Pediatric Urology
- Neurourology
- Radiology
Background:
- Sacral underdevelopment, identified by a subnormal sacral ratio (SR), may impact bladder function in infants.
- Understanding this association is crucial for diagnosing and managing lower urinary tract issues.
Purpose of the Study:
- To investigate the relationship between sacral underdevelopment (subnormal SR) and increased maximum detrusor voiding pressure (P det. Max) in infants.
- To determine if sacral ratio is a predictor of elevated P det. Max.
Main Methods:
- Retrospective cohort study of 45 infants undergoing pyeloplasty for congenital ureteropelvic junction obstruction.
- Sacral ratio (SR) calculated from pre-operative voiding cystourethrogram (VCUG) KUB radiography.
- Maximum detrusor voiding pressure (P det. Max) measured intraoperatively via suprapubic catheter.
Main Results:
- Infants with SR < 0.74 exhibited significantly higher P det. Max (167.5 ± 60.8 cmH2O) compared to those with SR ≥ 0.74 (55.7 ± 17.9 cmH2O).
- SR remained a significant predictor of P det. Max after adjusting for age and sex (p < 0.001).
- Physiologic detrusor sphincter dyscoordination (PDSD) was more prevalent in the SR < 0.74 group (100%) versus the SR ≥ 0.74 group (70.6%).
Conclusions:
- Lumbosacral underdevelopment, indicated by subnormal sacral ratios, is associated with sphincter-detrusor dyscoordination.
- This dyscoordination can lead to physiologic detrusor sphincter dyscoordination (PDSD) and elevated P det. Max in infants.
- SR measurement may serve as a valuable indicator for potential bladder dysfunction in infants.
Objective:
To investigate the association between sacral underdevelopment, as defined by subnormal sacral ratio (SR) measurements, with increased maximum detrusor voiding pressure (P det. Max) in infants.
Methods:
In this 2007-2015 retrospective cohort study, the medical records of all infants who underwent a pyeloplasty due to congenital ureteropelvic junction obstruction were added. Their P det. Max was evaluated through the suprapubic catheter utilized for urinary drainage intraoperatively, without imposing any additional risk of urethral catheterization on the infant. SR was calculated via the plain kidney, ureter, and bladder (KUB) radiography film obtained during the voiding cystourethrogram (VCUG) evaluation before the surgery. Participants were categorized into SR < 0.74 or SR ≥ 0.74. P det. Max was subsequently compared between these two groups.
Results:
A total of 45 patients were included in our analysis. Twenty-eight (62.2%) patients had a (SR < 0.74), while 17 (37.8%) had a (SR ≥ 0.74). P det. Max was shown to be significantly higher in the SR < 0.74 compared to the SR ≥ 0.74 group (167.5 ± 60.8 vs. 55.7 ± 17.9 cmH2O, p < 0.001). After adjusting for age and sex, SR remained a significant contributor to P det. Max (p < 0.001). Physiologic detrusor sphincter dyscoordination (PDSD) rate was significantly higher in the SR < 0.74 versus SR ≥ 0.74 group (100.0% vs. 70.6%, respectively; p = 0.005).
Conclusion:
Lumbosacral underdevelopment, as indicated by subnormal sacral ratios, is associated with sphincter-detrusor dyscoordination, which causes PDSD and can ultimately result in higher P det. Max in infants.
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