Non Invasive Urodynamic Assessment in Children-Are They Reliable? Validation of Non-Invasive Urodynamics in Children with Functional Voiding Disorders.
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Date
2010-12
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Abstract
Objectives To validate the non-invasive tests that can
predict the type of bladder dysfunction normally diagnosed
by invasive urodynamics.
Methods Children below 12 yrs of age were evaluated
prospectively. Non-invasive urodynamic evaluation included
history, clinical examination, frequency volume charting,
ultrasonographic scan, urine analysis and renal function
tests. Micturating cystourethrogram was carried out in
children with recurrent urinary tract infections. All children
underwent invasive urodynamic studies and the significance
of association of the parameters of noninvasive
assessment with invasive urodynamics was determined.
Chi square test using Epi 6 software was used for statistical
analysis of data.
Results 41 children underwent invasive urodynamic studies.
The commonest disorder was detrusor instability in 28 (68.2%).
Dysynergic voiding was noted in 8 (19.5%). The study was
normal in 5 (12.1%). Nocturnal enuresis with day time
symptoms, holding maneuvers, small frequent voiding pattern
(p<0.05) and a small capacity bladder with insignificant
residue (p=0.0003) predicts detrusor instability. Straining (p=
0.0006), large capacity bladder with significant post void
residue in the absence of vesicouretric reflux (p<0.05)
predicts dysyneric voiding. On combining the various noninvasive
tests and validating them against invasive urodynamics
in diagnosing detrusor instability and dysnergic voiding, they
have a sensitivity of 88.4% and 87.5%, specificity of 72.7% and
69.2%, positive predictive value of 0.88 and 0.63 and positive
likelihood ratio of 3.1 & 2.2 respectively.
Conclusions Functional voiding disorders can be diagnosed
with reasonable accuracy by minimally invasive methods.
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Keywords
Functional voiding disorders, Detrusor instability, Dysynergic voiding, Urodynamic studies
Citation
Ramamurthy H Ravi, Kanitkar Madhuri. Non Invasive Urodynamic Assessment in Children-Are They Reliable? Validation of Non-Invasive Urodynamics in Children with Functional Voiding Disorders. Indian Journal of Pediatrics. 2010 Dec ; 77 (12): 1400-1404.