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S22: NEUROPATHIC BLADDER
Moderators: Raimund Stein (Germany), Linda Shortliffe (USA)
ESPU Meeting on Saturday 17, October 2015, 09:03 - 09:51
09:03 - 09:06
S22-1
(PP)
★
CAN 4-HOUR VOIDING OBSERVATION DETECT NEUROGENIC BLADDER
DYSFUNCTION IN NEONATES WITH ANORECTAL MALFORMATION ?
Helena BORG, Charlotte ARWIDSSON, Gundela HOLMDAHL and Ulla SILLÉN
Queen Silvia Children's hospital, Department of Pediatric surgery, Gothenburg, SWEDEN
PURPOSE
Neurogenic bladder dysfunction (NBD) is present in about 25% of patients with anorectal malformation (ARM). The aim
was to determine if non-invasive investigation of bladder function with 4-hour voiding observation (FVO) can replace
cystometry in diagnosing NBD.
MATERIAL AND METHODS
FVO was performed in 34 patients pre- and post anorectal surgery (median age 4 and 14 months respectively),
including registration of voiding pattern, number of voiding(≤8), leakage, bladder capacity(≥50% of expected) and
mean residual (ultrasound, ≤10ml). For diagnosis of NBD, cystometry was performed. Bladder function was also
followed longitudinally with a structured questionnaire and flow-residual measurements.
RESULTS
All patients with cystometric diagnosed NBD (n=9) or non-neurogenic neurogenic dysfunction (n=1) presented abnormal
voiding variables. Mild abnormalities were registered in 3 girls with tethered cord: Voiding frequency (10-13) and
residual (mean 10-14 ml) were increased and bladder capacity <50%. A pathologic voiding pattern was seen in 5 boys
with spinal cord malformation: Urinary leakage, small voided volumes, frequent voiding (13-22) and incomplete
emptying. High bladder capacity and large residual were recognized in the remaining two patients.
The majority of patients, without known NBD or severe functional disturbance (n=24), had normal voiding pattern. A
moderate increase in residual was seen in 5 patients and with high bladder capacity in two. These 5 patients had periods
with bladder dysfunction during follow-up.
CONCLUSIONS
4-hour voiding observation can detect NBD in patients with ARM, especially severe dysfunction, and can therefore be
used for screening of NBD. However, it cannot replace cystometry in follow-up of patients with NBD.