Paediatric urodynamics

CHAPTER 10 Paediatric urodynamics



INTRODUCTION


Lower urinary tract dysfunction is common in children from both non-neurogenic and neurogenic causes. Most cases are well-recognized functional voiding disorders or have an underlying abnormality such as bladder outlet obstruction, and diagnosis does not depend upon the use of urodynamics. As a general rule, urodynamics is not routinely required in the evaluation of non-neurogenic paediatric voiding dysfunction, since in most cases adequate diagnosis and treatment can be based upon a thorough history and physical examination with appropriate use of endoscopy and radiography. However, urodynamic studies are important investigations in the evaluation and treatment of children with neurogenic bladder dysfunction, commonly due to spinal abnormalities.


Paediatric urodynamics is a highly specialized field and should only be performed in centres with the necessary equipment and expertise.



PAEDIATRIC LOWER URINARY TRACT DYSFUNCTION


As in adults, lower urinary tract dysfunction in children can be categorized as either storage or voiding. These include:


• Storage
image Incontinence
image urgency incontinence (most frequent)

image overflow incontinence

image other causes of incontinence

image Nocturnal enuresis.

• Voiding
image Functional obstruction

image Mechanical obstruction.

Nocturnal enuresis is ‘bedwetting’ after the age of 5 years, with no other urinary tract dysfunction. Urodynamic studies are generally not required in the assessment of nocturnal enuresis. Incontinence may be due to a number of causes and a urodynamic study may be helpful in determining the cause and planning the management. Mechanical obstruction in boys may be due to urethral valves, phimosis or meatal stenosis; in girls it may be due to urethral stenosis. Functional obstruction is due to detrusor sphincter dyssynergia (DSD) secondary to a neurological abnormality or secondary to poor relaxation of the pelvic floor and urethral sphincter mechanism.



HISTORY AND EXAMINATION


Most non-neurogenic childhood urinary tract dysfunction do not require urodynamics, therefore a detailed history and physical examination is required to:


• characterize the bladder dysfunction

• look for underlying organic disease

• identify common functional voiding syndromes.

A detailed voiding history is essential and should include:


• age and results of toilet training

• occurrence of primary or secondary enuresis

• specific pattern of wetting, such as stress incontinence, continual dripping or urge incontinence

• manoeuvres used to prevent wetting such as squatting, leg crossing, dancing or ‘Vincent’s curtsy’ (see below)

• frequency of daytime and night-time micturition.

Physical examination should include:


• inspection of the genitalia

• palpation of the lumbosacral spine to detect vertebral defects or sacral agenesis

• examination of the skin overlying the spine for hairy patches, dimples or bumps that might indicate occult spinal abnormalities

• inspection of the lower extremities for subtle neuropathy-related bony abnormalities

• a careful neurological examination.

Investigations should include:


• urinalysis

• post-void residual estimation.
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Related posts:

Clinical evaluation of the lower urinary tract Urodynamic procedures Basic structure, function and control of the lower urinary tract Pressure/flow cystometry Voiding disorders and bladder outlet obstruction Storage disorders and incontinence

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Jul 20, 2016 | Posted by in UROLOGY | Comments Off on Paediatric urodynamics

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