Integrated Ultrasound With Urodynamics Illustrates Effect of Bladder Volume on Upper Tract Dilation: Should we Trust Surveillance Ultrasounds?

Autor: Snow-Lisy DC; Swedish Pediatric Specialty Care, Swedish Hospital, Seattle, WA. Electronic address: devon.snow@swedish.org., Nicholas J; Rainbow Babies & Children's Hospital, Department of Radiology, Cleveland, OH., Sturm R; Department of Urology, University of California Los Angeles, Los Angeles, CA., Halline C; Department of Urology, University of California Los Angeles, Los Angeles, CA., Diaz-Saldano D; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL., Rosoklija I; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL., Diaz EC; Advocate Children's Medical Group, Advocate Health Care, Park Ridge, IL., Cheng E; Advocate Children's Medical Group, Advocate Health Care, Park Ridge, IL., Yerkes EB; Advocate Children's Medical Group, Advocate Health Care, Park Ridge, IL.
Jazyk: angličtina
Zdroj: Urology [Urology] 2022 Jan; Vol. 159, pp. 203-209. Date of Electronic Publication: 2021 Aug 21.
DOI: 10.1016/j.urology.2021.08.007
Abstrakt: Objective: To evaluate if ultrasound during urodynamics (uUS) will show that traditional ultrasound (tUS) routinely underestimates the potential magnitude of upper tract dilation (UTD).
Methods: Prospective pilot study of 10 consecutive patients ≥ 5 years of age undergoing same day uUS and tUS. Using randomized images, the study pediatric radiologist determined anterior-posterior renal pelvic diameter (APD), bladder volume, vesicoureteral reflux (VUR) and UTD grades. A single pediatric urologist determined urodynamic bladder capacity and assigned either hostile, intermediate, abnormal but safe, or normal national spina bifida patient registry classification (NSBPR).
Results: Bladder volume on tUS was significantly smaller than final bladder volume on uUS (180 vs 363 ml: P<.001). On average, patient reported maximum catheterized/voided volumes were also 82 ml greater than final bladder capacity on uUS. UTD was upgraded in 25% of kidneys and APD increased by 0.6 cm on uUS over that seen on tUS (P=.001). Units with VUR had greater increases in APD (1.2 P=.007 vs. 0.3 cm P=0.06). Changes in APD stratified by NSBPR revealed average increases of up to 1.3 cm.
Conclusion: Despite instructions to the contrary, patients come for tUS with a relatively empty bladder as compared to either their urodynamic or patient-reported capacity. This translates to a significant underestimation of UTD with tUS, most notably in those with VUR. Alternatives to traditional protocols include insisting patients wait until their bladder is truly full for tUS, retrograde filling their bladder, or performing uUS. Accurate assessment of UTD severity may help guide long term management.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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