Detrusor Pressures Change with Repeating Filling Cystometry in Myelodysplastic Children with Neurogenic Lower Urinary Tract Dysfunction.

International Children's Continence Society (ICCS) recommends urodynamics repeated at least twice for the optimal result. We aimed to search if three times repeating filling urodynamics in the same session would change the urodynamics parameters in children with neurogenic lower urinary tract dysfunction (NLUTD) due to myelodysplasia.

We investigated urodynamic reports and charts of 80 consecutive children with NLUTD due to myelodysplasia who underwent three repeating same session filling cystometry study between June 2017 and December 2018. Maximum detrusor pressure (pDetmax), maximum cystometric capacity (MCC), detrusor leak point pressure (DLPP), compliance, residual urine volume, and MCC/EBC (estimated bladder capacity for age) ratio were compared among all three filling cystometries.

The median age was 4.3 (IQR=5.8) years. 39 (48.75%) were girls and 41 (51.25%) were boys. Primary pathology was myelomeningocele in 69 (86.3%) patients. MCC, compliance, residual urine, and MCC/EBC were found comparable in three repeating cystometries. However, pDetmax at first filling was higher compared to others (2nd, p=0.015 and 3rd, p=0.002). DLPP at the first filling was also higher compared to third (p<0.001). Detrusor overactivity (DO) was persistent in all three fillings in 85% (n=68/80). 85% (68/80) remained in the same risk group according to DLPP (a cut-off of 40 cmH2O).

MCC and DO are comparable in three repeating cystometries but, detrusor pressures significantly decrease in the repeating fillings. In our practice, we plan our management according to the most worrisome urodynamics parameters for a safer proactive approach.

The Journal of urology. 2020 Sep 08 [Epub ahead of print]

Raziye Ergun, Cagri Akin Sekerci, Yiloren Tanidir, Bahriye Atmis, Atilla Gemici, Selcuk Yucel

Pediatric Urology, Erzurum Training and Research Hospital, Erzurum, Turkey., Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey., Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey., Pediatric Nephrology, Erzurum Training and Research Hospital, Erzurum, Turkey.