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ESPUN S3: NEUROPATHIC BLADDER
Moderators: Louiza Dale (UK) & Hanny Cobussen (Netherlands)
ESPU-Nurses Meeting on Thursday 15, October 2015, 09:00 - 09:35
09:00 - 09:10
ESPUN S3-1
(O)
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.