Role of Free-Flow Uroflowmetry as an Adjunct in Management of Urinary Tract Dysfunction for Children "At-Risk" for...

Invasive urodynamic study(UDS) remains the gold-standard test for diagnosing and characterizing the neurogenic bladder. UDS being an invasive test is difficult to implement as a screening test for children who are predisposed for neurogenic bladder. An observational study was conducted to evaluate the urodynamic features of lower urinary tract dysfunction (LUTD) in follow-up pediatric surgical (nonurological primary etiology) cases "at-risk" for neurogenic bladder and the efficacy of noninvasive uroflowmetry was assessed.

A prospective study was done from November 2019 to December 2022. All the postoperative patients with a history of primary non-urological congenital anomalies, aged less than 15 years presenting with LUTD were included. Noninvasive free-flow uroflowmetry and invasive UDS were done for these patients. Abnormal UDS defined in terms of voiding pattern was compared with abnormal uroflowmetry defined as inadequate Qmax and nonbell shaped flow curve.

Thirty-four children with primary diagnosis of spina-bifida (n = 12), anorectal malformation (n = 20), and sacrococcygeal teratoma (n = 2) were included, who presented with LUTD at a mean age of 4.76 ± 1.60 years. 29.4% children had acontractile bladder at presentation. Abnormal findings of uroflowmetry were comparable to abnormal findings of UDS (p > 0.05; kappa > 0.7). Uroflowmetry had sensitivity of 88.2% and specificity of 82.3% in diagnosing neurogenic bladder.

Delayed presentation of neurogenic bladder with irreversible detrusor changes in predisposed cases highlights the need for stringent follow-up. Noninvasive uroflowmetry has high sensitivity and specificity with respect to invasive UDS in identifying neurogenic bladder in predisposed cases; it can be implemented as a routine screening test in predisposed cases to identify the at-risk cases in advance of clinical symptoms.