BERKELEY, CA (UroToday.com) - The cerebral palsy patient population is a heterogeneous group, and there are few studies addressing the issue of lower urinary tract symptoms in this population. The prevalence of lower urinary tract dysfunction is very high in patients with cerebral palsy and the pediatrician may have doubt, either in making a simple clinical diagnosis of the condition or whether to resort to invasive tests such as urodynamics.
In addition to this paper, the principal author of the study, Dr. J.A. Fernandes Silva, has also published studies on this issue with cohorts from a prestigious Brazilian institution, the SARAH Network of Rehabilitation Hospitals. Those studies, along with the current one, are briefly summarized below.
The first study evaluated 37 children, mean age of 7 years, with cerebral palsy and lower urinary tract symptoms. They were submitted to urodynamic evaluation and our conclusion was that although bladder dysfunction is common in the symptomatic population, the urodynamic evaluation might have been avoided in almost all cases. The most frequent urodynamic findings were reduced bladder capacity, detrusor overactivity, and an increased post-void residual. These patients should first be managed by bladder diary, uroflowmetry, and ultrasonography. The urodynamic evaluations were normal in one-third of these children with lower urinary tract symptoms. No upper urinary tract complications were observed.
The second study assessed 47 children with mean age of 8 years. The patients were both symptomatic and asymptomatic for LUTS. All children underwent a urinary questionnaire and urinary tract ultrasonography with assessment of bladder wall thickness. Lower urinary tract dysfunction occurred in 60.8% of the children, and urinary incontinence was present in 44.3%. The conclusion of this study was that lower urinary tract dysfunction is very common in children with cerebral palsy and bladder wall thickness did not correlate with the presence of bladder dysfunction or incontinence.
In the present article the objective was to evaluate uroflow measurements in the initial management of children and adolescents with cerebral palsy and lower urinary tract dysfunction. Fifty-four patients were evaluated by a clinical urologic practitioner. They reported their urinary symptoms, underwent physical examination, urinary tract ultrasonography, and uroflowmetry. The conclusion was although lower urinary tract symptoms are common in patients with cerebral palsy, gender, ambulatory status and the distribution of the paralysis do not affect Qmax or flow pattern, but symptomatic patients present lower Qmax and have an abnormal uroflow curve. Therefore uroflowmetry may be useful in the evaluation of lower urinary tract dysfunction in the cerebral palsy patients.
Based on these publications, we can recommend a non-invasive evaluation, with a detailed history and physical examination, supplemented whenever necessary with an uroflowmetry and ultrasonography, for evaluation of patients with cerebral palsy and lower urinary tract symptoms. The urodynamic study is reserved for special cases when an uncomplicated evaluation is not sufficient to guide treatment.
- Silva JA, Alvares RA, Barboza AL, Monteiro RT. Lower urinary tract dysfunction in children with cerebral palsy. Neurourol Urodyn. 2009;28(8):959-63. doi: 10.1002/nau.20714.
- Silva JA, Gonsalves Mde C, Saverio AP, Oliveira IC, Carrerette FB, Damião R. Lower urinary tract dysfunction and ultrasound assessment of bladder wall thickness in children with cerebral palsy. Urology. 2010 Oct;76(4):942-5. doi: 10.1016/j.urology.2010.04.005. Epub 2010 Jul 1.
Fabricio Borges Carrerette, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Professor of Urology, State University of Rio de Janeiro, Brazil