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The sensitivity of pressure specific bladder volume versus total bladder capacity as a measure of bladder storage
E H Landau1, B M Churchill, V R Jayanthi
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pressure specific bladder volume is a superior measure of bladder storage function in children with neurogenic bladders compared to total bladder capacity. This objective method accurately assesses bladder dysfunction by relating volume to pressure.
Area of Science:
- Pediatric Urology
- Urodynamics
- Bladder Dysfunction
Background:
- Assessing bladder storage function is crucial for managing pediatric neurogenic bladder.
- Standard clinical criteria include upper urinary tract deterioration, incontinence, and infection.
- Accurate measurement of bladder capacity and pressure is essential.
Purpose of the Study:
- To evaluate the efficacy of pressure specific bladder volume as a measure of bladder dysfunction in children with neurogenic bladders.
- To compare pressure specific bladder volume with total bladder capacity.
- To determine if pressure specific bladder volume offers a more objective assessment.
Main Methods:
- Studied 21 consecutive children with neurogenic bladders undergoing evaluation for bladder augmentation.
- Measured pressure specific bladder volume and total bladder capacity.
- Compared urodynamic indexes to established nomograms.
Main Results:
- All 21 patients exhibited bladder volumes below the 5th percentile at pressures of 30 cm water or less.
- In 33% of patients, normal total bladder capacity was achieved with elevated storage pressures.
- Pressure specific bladder volume was found to be objective and reproducible.
Conclusions:
- Pressure specific bladder volume is a more effective measure of bladder storage function than total bladder capacity in pediatric neurogenic bladder.
- This method provides a better assessment by relating bladder volume to intravesical pressure.
- It offers an objective and reproducible alternative to subjective measures.
Abstract:
Assessment of bladder storage function requires an accurate measure of bladder capacity and pressure. Pressure specific bladder volume is the volume that a bladder can accommodate at a specific pressure. A total of 21 consecutive children with neurogenic bladders who were candidates for bladder augmentation based on standard clinical criteria (upper urinary tract deterioration, incontinence and infection) was studied to determine the efficacy of pressure specific bladder volume as a measure of bladder dysfunction. Urodynamic indexes were compared to previously established nomograms. All 21 patients had bladder volumes at pressures of 30 cm. water or less, which decreased below the 5th percentile as determined by the nomogram. In 7 patients (33%) normal total bladder capacity was achieved at the expense of elevated storage pressures. Pressure specific bladder volume provides a better measure of bladder storage function than total bladder capacity because it relates volume to intravesical pressure, does not rely on a subjective end point to bladder filling, and is objective and reproducible.