Urodynamic studies in pediatric urology

• Published in: Nature reviews. Urology Vol. 6; no. 11; pp. 585 - 594
• Main Authors: de Jong, Tom P. V. M, Klijn, Aart J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-11-2009; Nature Publishing Group
• Subjects: Accreditation; Bladder; Care and treatment; Catheters; Child; Defecation; Diagnosis; Diaries; Humans; Kidney function tests; Medical education; Medicine; Medicine & Public Health; Patient outcomes; Pediatrics; Pelvis; review-article; Risk factors; Ultrasonic imaging; Urinary Bladder Diseases - diagnosis; Urinary Bladder Diseases - physiopathology; Urodynamics; Urogenital system; Urologic diseases; Urologic Diseases - diagnosis; Urologic Diseases - physiopathology; Urology; Netherlands
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2009.200

Knowing when to request invasive urodynamic tests in children can be difficult, but persisting with nonbeneficial treatment is a serious failure of care. In this concise Review, authors from The Netherlands provide straightforward guidance on appropriate use of urodynamic studies in pediatric patients with overactive bladder, underactive bladder, neurogenic bladder and dysfunctional voiding.
In any type of lower urinary tract dysfunction it is mandatory to obtain as much information as possible on the function of the urinary tract. By definition of the International Continence Society, any investigation that produces such information is part of urodynamics. Thus, voiding and defecation history, physical examination, voiding frequency charts and defecation diaries are all essential parts of urodynamics. Repeated free uroflowmetry is considered an essential routine investigation by the International Children's Continence Society. Static and dynamic ultrasonography of the lower urinary tract and the pelvic floor can give important information on lower urinary tract anatomy and function, in a noninvasive manner. Invasive urodynamic studies such as voiding cystourethrography and cystometry are reserved for patients for whom the outcome of such studies is expected to change the therapeutic regime. Invasive urodynamic tests are performed primarily for one of two reasons. First, to confirm an expected diagnosis in new patients. Second, to ensure that the storage pressures in the bladder remain safe for normal functioning of the kidneys in children with chronic disease.
Key Points
Any information on the function of the urinary tract is part of urodynamics; a meticulous micturition and defecation history with voiding and defecation diary are invaluable in pediatric patients
Invasive urodynamic studies are done to obtain information that directs or changes the treatment of the individual child
When diagnosis is done properly, straightforward therapy can be given and the psychological trauma associated with failure to respond to ill-defined treatment strategies can be avoided
In patients with chronic lower urinary tract dysfunction of neurogenic origin or after severe obstructive uropathy, invasive urodynamic studies ensure that bladder pressures remain safe, to protect kidney function
In a patient with lower urinary tract symptoms, any sign of structural anomalies must be investigated to exclude neurogenic bladder dysfunction