ABSTRACT
PURPOSE: To investigate whether ultrasonographic bladder wall thickness (BWT) correlates with urodynamic parameters in patients with spinal cord injury (SCI). METHODS: Two hundred and seventy-two patients with SCI were enrolled in the study. All of the patients underwent bladder ultrasonography and urodynamic study. The anterior bladder wall was measured and compared to urodynamic data. RESULTS: The mean age of the patients was 37.4 years. The mean BWT was 3.9 mm. BWT was significantly higher in the patients with neurogenic detrusor overactivity associated with detrusor sphincter dyssynergia (NDO/DSD) compared to those without sphincter dyssynergia (4.2 vs. 3.6 mm, respectively, p < 0.001) and in those with compliance <20 ml/cm H2O. Nevertheless, ROC curve analysis [ROC = 0.624, 95 % CI (0.530, 0.718), p = 0.011] showed that no meaningful BWT measurement cutoff could be made to predict an elevated detrusor pressure in the storage phase. CONCLUSIONS: Increased BWT was present in patients with low bladder compliance and NDO/DSD. No BWT cutoff value to predict an elevated detrusor pressure was found. Therefore, the measurement of BWT has no clinical role in patients with SCI and cannot replace urodynamic evaluation.
Subject(s)
Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/diagnostic imaging , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder, Overactive/diagnostic imaging , Urinary Bladder, Overactive/physiopathology , Urodynamics/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Paraplegia/diagnostic imaging , Paraplegia/etiology , Paraplegia/physiopathology , Predictive Value of Tests , Quadriplegia/diagnostic imaging , Quadriplegia/etiology , Quadriplegia/physiopathology , ROC Curve , Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/physiopathology , Ultrasonography , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Overactive/etiology , Young AdultABSTRACT
OBJECTIVES: To evaluate lower urinary tract dysfunction (LUTD) based on questionnaire symptom scoring and ultrasound assessment of bladder wall thickness (BWT) in children with cerebral palsy (CP). METHODS: A total of 97 children with CP were enrolled in the study. The patients were either symptomatic or asymptomatic with respect to lower urinary tract symptoms. All children underwent a urinary questionnaire and renal ultrasonography. Ultrasound assessment of BWT was completed in 72 cases. RESULTS: A total of 47 patients were female and 50 were male. The mean age was 8 years 8 months (SD 3 years 1 month), with a range of 5-18 years. Urinary incontinence was present in 43 patients (44.3%). Based on the questionnaire, LUTD was found in 59 patients (60.8%). The mean BWT was 2.30 mm. There was no statistically significant difference between continent and incontinent children (2.46 vs 2.19 mm) or between children with and without LUTD (2.43 vs 2.12 mm). CONCLUSIONS: LUTD is common in children with CP and occurred in 60.8% of the patients assessed. BWT did not correlate with the presence of bladder dysfunction or incontinence. Ultrasound assessment of BWT was not relevant for diagnosis of lower urinary tract dysfunction.
Subject(s)
Cerebral Palsy/complications , Urinary Bladder/diagnostic imaging , Urination Disorders/etiology , Adolescent , Cerebral Palsy/pathology , Child , Child, Preschool , Constipation/etiology , Constipation/pathology , Female , Humans , Kidney/diagnostic imaging , Male , Paraplegia/etiology , Quadriplegia/etiology , Severity of Illness Index , Ultrasonography , Urinary Tract Infections/diagnostic imaging , Urinary Tract Infections/etiology , Urinary Tract Infections/pathology , Urination Disorders/diagnostic imaging , Urination Disorders/pathologyABSTRACT
AIMS: The focus of this study was to evaluate urodynamic findings and possible renal damage in children with cerebral palsy and urinary symptoms. METHODS: Children with cerebral palsy and lower urinary tract symptoms were studied. Patients were submitted to urodynamic evaluation, urine examination, measurement of serum creatinine, and renal and urinary tract ultrasonography. Voiding cystourethrography was performed on patients with urinary tract infections. RESULTS: Thirty-seven children were investigated, including 21 females and 16 males. The mean age was 7 years and 8 months [SD of 4 years 6 months], with a range from 1 to 17-year-old. The symptoms that led to evaluation were urinary infections in 21 56.7% cases, incontinence in 15 (40.5%) cases, increased voiding frequency in six (16%) cases, enuresis in five (13.5%) cases, and hesitancy and urgency in two (5.4%) cases each. The urodynamic findings involved reduced bladder capacity in 20 (54%) cases, with mean cystometric capacity of 168.0 +/- 122.2 ml. Detrusor overactivity was observed in 13 (35.1%) cases, with mean of 67.9 +/- 34.6 cmH(2)O. The range of the residual volume was 17.5 +/- 33.5 ml, which was increased in five (13.5%) cases. Low bladder compliance was seen in four (10.8%) patients, mean bladder compliance of 22.2 +/- 12.2 ml/cmH(2)O. No hydronephrosis or reflux was observed. CONCLUSION: Almost one-third of the patients with cerebral palsy and urinary symptoms presented with normal urodynamic findings. The most frequent findings were reduced bladder capacity, detrusor overactivity, and increased post-void residual. No urinary tract complications were observed.
