A Comparative Study Of Non Invasive And Invasive Urodynamic Assessment Of Bladder Dysfunction In Children

Background and purposeLower urinary tract dysfunction(LUTD) is a common disease in children, and may present urinary incontinence, urinary tract infection, vesicoureteral reflux(VUR) and /or intestinal constipation. Epidemiological study showed the rates of urinary incontinence and enuresis as high as 10% in school-age children. It may influence children’s quality of life, effect the study and normal grow up in future. According to the International Continence Society(ICS) definition, these children should use some methods to give information of lower urinary tract, such as voiding history, physical examination, voiding diary and urodynamic study. The urodynamic study(UDS) has become common practice in the evaluation of infants and children with bladder dysfunction. It has the ability to give the etiology diagnosis and evidence-based programs for therapy. The urodynamic study consist of invasive urodynamic study(IUDS) and non invasive urodynamic study(NIUDS). It is well known that invasive urodynamic Study(IUDS) is the gold standard for evaluation of bladder dysfunction. However, its side effects are pain, hematuria and discomfort, occasional difficult to perform, although sometimes the reason is fear and un-cooperation. Recently, non invasive urodynamic Study(NIUDS) is more and more used to evaluation bladder dysfunction in children. The aim of present study is to evaluate its value in assessment of bladder dysfunction in Children. Materials & MethodsThis study included 155 cases(boys 106, girls 49, aged from 5 to 18 y, averaged 10.46±3.55 y) with bladder dysfunction. NIUDS and IUDS were performed in all cases according to the recommendations from International Children’s Continence Society(ICCS) including uroflowmetry, PVR measured by ultrasound. The detrusor function was graded into 3 groups, overactivity, normal and under activity according to NIUDS which compared to those from IUDS by using Chi-square test. The criteria of diagnosis: detrusor overactive indicated by Pdet>100cm H2 O in IUDS, Qmax≥15 ml/s, PVR≤20 ml; detrusor underactive indicated by Pdet< 40 cm H2O in IUDS, Qmax≤15 ml/s, PVR>20 ml. ResultsNIUDS had shown 54 cases with detrusor overactivity, 74 normal and 27 under activity, while in IUDS, 26 overactivity, 98 normal and 31 under activity. There was a significant difference between the both methods(p<0.05). It had a statistical difference when detrusor was overactivity(p<0.05), while there was no difference when detrusor was under activity(p>0.05).The sensitivity, specificity and accuracy of NIUDS were 77%, 74% and 65% in detrusor overactivity, 62%, 77% and 68% in normal, and 81%, 98%, 95% in under activity, respectively. ConclusionThe sensitivity and specificity of NIUDS is good in children with detrusor under activity, but it cannot take the place of IUDS in evaluating bladder dysfunction in children. However, for screening the bladder dysfunction, the IUDS will show its advantage especially doubting the children with bladder under activity.