Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

15:46 - 15:49

S27-6

(PP)

PRESSURE AT PRESENTING VOLUME (PPV) TO EVALUATE THE VALIDITY OF

URODYNAMIC TESTING

Martin KAEFER

, Rebecca GERBER

, Shelly KING

, Melissa YOUNG

, Rosalia MISSERI

, Benjamin WHITTAM

, Katherine

HUBERT

, Konrad SZYMANSKI

, Richard RINK

and Mark CAIN

1) Riley Hospital for Children, Pediatric Urology, Indianapolis, USA - 2) Indiana University Medical School, Pediatric

Urology, Indianapolis, USA

PURPOSE

Urodynamic evaluation plays a key role in the evaluation and treatment of patients with bladder dysfunction. However,

due to the artificial nature of filling, pressures can at times be falsely elevated and hence not accurately reflect bladder

behavior. Using the initial bladder pressure at the time of patient presentation provides a natural fill data point that can

be used to assess the validity of this clinically important test.

MATERIAL AND METHODS

Patients presenting for cystometry between January 2010 and December 2013 underwent measurement of bladder

pressure upon insertion of the urodynamic catheter. Presenting volume and the pressure measured before draining this

urine (Pressure at Presenting Volume: PPV) were recorded. When a volume equal to the presenting volume had been

instilled during cystometry, this point on the tracing was labeled filling pressure (FP).

RESULTS

A total of 309 patients were evaluated. Indications for the urodynamic evaluation included neurogenic bladder (133),

bladder dysfunction (84), evaluation for tethered cord (53), cerebral palsy (16), pathology related to bladder outlet

obstruction (9), and other (14). In one-third of cases the PPV recorded prior to initiating the study was significantly

lower than the FP measured during the study (34%, N=104). Patients presenting with their bladder containing 75%-

100% of expected bladder capacity were significantly more likely to have a PPV lower than the FP measured during the

cystometrogram (relative to patients who presented with a less distended bladder) (p = 0.03).

CONCLUSIONS

Pressure at Presenting Volume (PPV) provides a simple means of assessing the validity of urodynamic pressures. This

may be most useful when the patient presents with a nearly full bladder. Use of this simple measurement has the

potential to limit the number of children who might otherwise undergo unnecessary intervention such as

enterocystoplasty.