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VR-44
(VS)
VIDEO-URODYNAMIC EVALUATION IN CHILDREN: STANDARDIZED EVALUATION
IN SITTING AND LYING POSITION
Anne-Francoise SPINOIT, Veerle DECALF, Inge RAGOLLE, Achilles PLOUMIDIS, Luitzen-Albert GROEN, Erik VAN LAECKE
and Piet HOEBEKE
UNIVERSITY HOSPITAL GHENT, Urology, Ghent, BELGIUM
PURPOSE
Video-Urodynamic studies (VUDS) in children are gold standard in diagnosis of neurogenic bladder dysfunction
(NBD). It allows identifying those children at risk for urinary tract deterioration if no intervention is done. Other children
presenting with therapy resistant lower urinary tract disorders (LUTD) can benefit from VUDS. According to the
International Children’s Continence Society (ICCS), in these children VUDS is recommended for characterization of their
non-neurogenic bladder dysfunction (NNBD), and/or to rule out NBD. A standardized procedure to perform VUDS in
children in a sitting and lying position is here presented.
MATERIAL AND METHODS
Data necessary to obtain urodynamic evaluation of bladder sphincter function are gathered by concomitant
measurement of bladder, urethral and abdominal pressure. A 7F transurethral double-microtip catheter (Gaeltec, Isle of
Skye, Scotland) is used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a
pressure transducer is inserted into the rectum for rectal pressure measurement. All presures are measured using a
transducer and recorded on computer. The bladder is filled through the trans-urethral tube using diluted contrast
medium with sterile water. Two filling cycles are done, one in sitting and one in lying position. Cystometry is combined
with fluoroscopy, providing simultaneous voiding cysto-urethrography. Detrusor activity, bladder sensation, capacity
and compliance are measured during filling cystometry. Filling rate is 10% of estimated bladder capacity (EBC) for age
per minute. In those with severe instability the filling rate was reduced to 5% of the EBC for age. Voiding cystometry
comprises recording of pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement
when possible.
RESULTS
VUDS are performed in NNBD and NBD children to allow further therapeutic decision.
CONCLUSIONS
A good and reproducible VUDS performed with a transurethral catheter is mandatory to allow correct therapeutic
decision in NNBD and NBD children. A standardised approach is presented in this video.