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ICCS S4-3
(LO)
CHARACTERISTICS OF PAEDIATRIC PATIENTS WITH IDIOPATHIC DETRUSOR
UNDERACTIVITY
Joanna CLOTHIER and Anne WRIGHT
Evelina London Children's Hospital, Paediatric Nephro-urology, London, UNITED KINGDOM
PURPOSE
Idiopathic detrusor underactivity (DU) is an uncommon diagnosis in paediatric patients. Our aim is to describe the
characteristics of this group.
MATERIAL AND METHODS
A retrospective, single centre, review of children diagnosed with DU was performed and data regarding demographic,
symptoms, diagnostic tests and management recorded. Values displayed as median (range).
RESULTS
From January 2010 to March 2015 we identified 24 patients, aged 9.7 years (5.2-14.8), 16 female (67%).Three (13%)
presented in urinary retention, 19(83%) were referred with urinary incontinence and 2 difficulty voiding. Symptoms
included: recurrent UTI (n=16,67%), abdominal pushing (n=15,63%), constipation (n=15,63%), infrequent voiding
(n=9,38%) and urgency (n=7,29%). Uroflow assessment was successfully completed in 20(83%) patients: fractionated
and staccato flows were diagnosed in 3(15%) and 6(30%), respectively. Nine (45%) had large and one (5%) small
capacity bladder (BC); overall BC was 135%(35-247%) of expected BC. In 19(95%) cases post-void residual was
present, which corresponded to 19% of BC (0-97%). All had ultrasound scan, 21% had abnormal upper tract findings;
renal scarring (DMSA) was present in 7/11 patients. Four children had renal impairment. Video-urodynamics findings
were: atonic bladders in 2/24(8%) unsustained bladder contractions in 21/24(88%). MaxpDet was 42cmH20(15-68), 1
girl had sustained but reduced strength (MaxpDet 29cmH20). Sixteen(67%) had bladder sensation, in 5(21%) vesico-
ureteric reflux, 5(21%) detrusor overactivity and 7(29%) were unable to void.
Fifteen (63%) patients were treated with CIC, while timed double-voiding and constipation management was
recommended to 9(37%).
CONCLUSIONS
Idiopathic DU should be considered in children presenting with urinary incontinence and/or voiding difficulties with a
normal-large capacity, incompletely emptying bladder.