Evaluation of bladder capacity in children with lower urinary tract symptoms: Comparison of 48-hour frequency/volume charts and uroflowmetry measurements.

INTRODUCTION: Objective evaluation of bladder capacity (BC) in children with lower urinary tract symptoms (LUTS) is important for recognizing types of bladder dysfunction. Bladder capacity is evaluated from 48-hour frequency/volume (48-h F/V) charts or by uroflowmetry with ultrasound post-void assessment. There are limited data on the reliability of both methods of assessment in children. OBJECTIVE: The aim of the study was to compare two modalities of assessment, (F/V chart and uroflowmetry) in cohorts of children with bladder dysfunctions. STUDY DESIGN: Maximum bladder capacity (MBC) obtained from 48-h F/V charts was compared with volumes calculated from uroflowmetry in a cohort of 86 children with different bladder dysfunctions. The BC obtained by the two modalities was compared for the three most frequent subtypes of bladder dysfunction: monosymptomatic nocturnal enuresis (MNE), overactive bladder (OAB), and dysfunctional voiding (DV). Considering a 48-h F/V chart as standard, the sensitivity, specificity, negative and positive predictive values of uroflowmetry measurements were calculated for detecting low bladder capacity. RESULTS: The mean maximal bladder capacity (188 ± 99.42 ml) obtained from home 48-h F/V chart measurement was 17 ml lower than the mean value obtained from uroflowmetry (205 ± 112.11 ml) (P = 0.58). The differences between bladder capacities estimated by 48-h F/V chart and uroflowmetry for subjects were not significant (Figure). Concordance between 48-h F/V chart and uroflowmetry categorization of BC was present in 64 (74%) subjects. The sensitivity and specificity of uroflowmetry, in comparison with 48-h F/V chart evaluation, for recognizing low bladder capacity were 75.5% and 73.17%. The sensitivity and specificity for the different types of LUTS achieved 68.42% and 58.83% for OAB, 80% and 83% for MNE, and 50% and 83.3% for DV. DISCUSSION: According to the International Children's Continence Society, the management of MNE in children can be made without uroflowmetry. History and MBC evaluation by 48-h F/V charts yields sufficient information. Nevertheless, in situations where F/V charts are unreliable or unavailable, uroflowmetry can be used as an alternative method. The highest discrepancy between both methods of BC evaluation was found in DV; this was mainly due to the mean PVR of 31 ml. CONCLUSION: For children with MNE, both 48-hour frequency/volume charts and triplicate urine flow measurement with PVR evaluation are reliable methods of maximum bladder capacity evaluation. For children with OAB or DV, both methods may be necessary for accurate evaluation of decreased BC, as F/V chart and uroflow results may not be comparable.

Routine day-case laparoscopic cholecystectomy.

BACKGROUND: A prospective study was carried out to assess the feasibility of performing true day-case laparoscopic surgery in a district general hospital. METHODS: All patients admitted consecutively under the care of one surgeon for laparoscopic cholecystectomy were included in the study. Selection criteria for a day-case procedure included an American Society of Anesthesiologists grade of I or II and the availability of a responsible carer at home. Patients were discharged 4-6 h after surgery with a standard analgesia pack and a contact number for advice. All patients were contacted by telephone on the day after discharge. A postal questionnaire was sent to the first 100 patients to assess satisfaction with the day-case process. RESULTS: Of 357 patients admitted for laparoscopic cholecystectomy over a 24-month period, 154 (43.1 per cent) were operated on as day cases on a morning theatre list. Twenty-two patients required an overnight stay (14.3 per cent), three because of conversion to an open procedure. One patient was readmitted for neck pain. Eighty-two (92.1 per cent) of 89 patients were either satisfied or very satisfied with the day-case procedure. CONCLUSION: This study has demonstrated a low rate of overnight stay (14.3 per cent) and readmission (1.9 per cent), and a high degree of patient satisfaction for day-case laparoscopic cholecystectomy.

Slow release dietary carbohydrate improves second meal tolerance.

Breakfasts of lentils or wholemeal bread of identical carbohydrate content were taken by seven healthy volunteers. The lentils produced a significant 71% (p less than 0.001) reduction in the blood glucose area and flattened the plasma insulin and gastric inhibitory polypeptide responses by comparison with the bread. In addition, the lentil breakfast was followed by a significantly flatter blood glucose response to the standard bread lunch which followed 4 h later (by 38%, p less than 0.01). The blood glucose pattern was mimicked by feeding the bread breakfast slowly over the 4 h before lunch. Giving a bread breakfast containing a quarter of the carbohydrate reduced the breakfast glucose profile but resulted in a significantly impaired blood glucose response to lunch (168% of control, p less than 0.01). These results, together with breath hydrogen studies, performed on a separate group of four volunteers, indicate that the flattened response to lentils is not due to carbohydrate malabsorption. Slow release or "lente" carbohydrate foods such as lentils may form a useful part of the diets of those with impaired carbohydrate tolerance.