WHAT HAPPENS TO THE BLADDER AT NIGHT? OVERNIGHT URODYNAMIC MONITORING IN CHILDREN WITH NEUROGENIC VESICAL DYSFUNCTION
| Autor: | M. Samuel, K. Wang, S.-A. Boddy |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Urology Hospital unit Transducers Urinary Bladder Bladder capacity Neurological disorder Humans Medicine Prospective Studies Urinary Bladder Neurogenic Child Monitoring Physiologic Neuropathic bladder medicine.diagnostic_test business.industry Reproducibility of Results Cystometry Mean age medicine.disease Surgery Urodynamics El Niño Anesthesia Female business Fill rate |
| Zdroj: | Journal of Urology. 165:2335-2340 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/s0022-5347(05)66198-8 |
| Popis: | We assess night and day function of the neuropathic bladder in children with neurogenic vesical dysfunction by overnight urodynamic monitoring and conventional static cystometrogram. Overnight urodynamics as a diagnostic tool was evaluated and its reproducibility analyzed.In 18 months 3 boys and 3 girls 6 to 14 years old (mean age plus or minus standard deviation 10.3 +/- 3.3) were studied prospectively. Each child was evaluated on 4 separate occasions with 2-daytime cystometrograms at a standard fill rate of 10 ml. per minute and 2 overnight urodynamic studies for 8 hours using a Urolog Recorder. All 6 children were interviewed regarding the acceptability, repeatability and compliance to overnight urodynamics.Bladder capacity was not significantly different during each episode for either of the 2 tests. Mean bladder pressures in 2 children showed stable detrusor activity on cystometry (2 +/- 1.4 cm. H2O) and overnight urodynamics (0.4 +/- 0.5, r = 0.9). Detrusor compliance was not impaired in these 2 children. Four patients had frank detrusor instability with a mean bladder pressure of 50.6 +/- 17.4 cm. H2O on cystometry versus 35.9 +/- 5.2 on overnight urodynamics (r = 0.9). Bladder compliance was severely impaired in these 4 patients. Compliance at potential bladder capacity for patient age was 6.6 +/- 2.1 ml./cm. H2O for cystometry versus 9.2 +/- 3.4 for overnight urodynamics (p = 0.26, r = 0.9). Compliance at actual bladder capacity was 3.4 +/- 1.2 ml./cm. H2O for cystometry versus 3.8 +/- 0.8 for overnight urodynamics (p = 0.28, r = 0.9). There was good correlation between daytime cystometry and overnight urodynamics (p0.001, Pearson's coefficient correlation 0.92, 95% confidence interval 0.90 to 0.94). A kappa statistical analysis showed good agreement between cystometry and overnight urodynamics for stable bladder and frank detrusor instability (kappa = 0.9). Replicated measurements of the same patient by the same observer had an error of variance of 1.7 cm. H2O with a narrow confidence interval, indicating the measurement error was small and that overnight urodynamics can be reproduced with relative accuracy within an individual. All 6 children preferred overnight urodynamics to cystometry.There was good correlation between bladder behavior day and night. Overnight urodynamics were accurate in predicting detrusor activity, and well tolerated and less embarrassing for a child with neurogenic vesical dysfunction. |
| Databáze: | OpenAIRE |
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