Advertisement
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
No AccessJournal of UrologyPediatric Urology1 Oct 2008

The Relevance of Urodynamic Studies for Urge Syndrome and Dysfunctional Voiding: A Multicenter Controlled Trial in Children

View All Author Information

Purpose:

The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome.

Materials and Methods:

In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment.

Results:

In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome.

Conclusions:

Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

References

  • 1 : Syndromes of vesical incoordination. Urol Clin North Am1980; 7: 311. Google Scholar
  • 2 : The uninhibited bladder in children: effect of treatment on recurrence of urinary infection and on vesicoureteral reflux resolution. J Urol1983; 130: 1138. LinkGoogle Scholar
  • 3 : Bladder-sphincter dysfunction, urinary infection and vesico-ureteral reflux with special reference to cognitive bladder training. Contrib Nephrol1984; 39: 190. Google Scholar
  • 4 : Vesicoureteral reflux and the unstable bladder. J Urol1985; 134: 1180. LinkGoogle Scholar
  • 5 : Conservative management of urinary incontinence in childhood. In: Incontinence. Edited by . Paris: Health Publication Ltd2002: 540. Google Scholar
  • 6 : Renal and bladder functional status at diagnosis as predictive factors for the outcome of primary vesicoureteral reflux in children. J Urol2006; 176: 1152. LinkGoogle Scholar
  • 7 : Micturition habits and incontinence at age 17—reinvestigation of a cohort studied at age 7. Br J Urol1995; 76: 231. Google Scholar
  • 8 : The natural history of urinary symptoms during adolescence. Br J Urol1998; 81: 90. Google Scholar
  • 9 : Postural control of urinary incontinence: The curtsy sign. Lancet1966; 2: 631. Google Scholar
  • 10 : Recurrent urinary tract infections in girls: effects of urethral dilatation. Br J Urol1973; 45: 72. Google Scholar
  • 11 : Distal urethral stenosis. J Urol1963; 89: 414. LinkGoogle Scholar
  • 12 : Standardization and definitions in lower urinary tract dysfunction in children. Br J Urol1998; 81: 1. Crossref, MedlineGoogle Scholar
  • 13 : Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials. J Urol2003; 170: 196. LinkGoogle Scholar
  • 14 : Pad tests in children with incontinence. Scand J Urol Nephrol1986; 20: 47. Google Scholar
  • 15 : Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux: The International Reflux Study in Children. J Urol1992; 148: 1699. LinkGoogle Scholar
  • 16 : The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol2006; 176: 314. LinkGoogle Scholar
  • 17 : International Reflux Study in Children: Reference ranges for cystographic bladder capacity in children—with special attention to vesicoureteral reflux. J Urol2006; 176: 1596. LinkGoogle Scholar
  • 18 : Comparison of standard therapy, bladder rehabilitation with biofeedback, and pharmacotherapy in children with non-neuropathic bladder-sphincter dysfunction. Neurourol Urodyn1999; 18: 261. Google Scholar
  • 19 : Overactive bladder symptoms: do we need urodynamics?. Neurourol Urodyn2003; 22: 105. Google Scholar
  • 20 : The Art and Science of Piddling: Voiding Habits of Man and Beast. In: . San Francisco: Vespasian Press1999: 20. Google Scholar
  • 21 : Social rank in house mice: differentiation revealed by ultraviolet visualization of urinary marking patterns. Science1973; 182: 939. Google Scholar
  • 22 : Sampling theorem. http://mathworld.wolfram.com/SamplingTheorem.html. Google Scholar
  • 23 : Sixth Report on the Standardisation of Terminology of Lower Urinary Tract Function. Procedures related to neurophysiological investigations: electromyography, nerve conduction studies, reflex latencies, evoked potentials and sensory testing. The International Continence Society. Br J Urol1987; 59: 300. Google Scholar
Advertisement