Department of Clinical Medicine, University of Aarhus, Aarhus N, Denmark; Urodynamic Center, Institute of Clinical Medicine & Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Clinical Medicine, University of Aarhus, Aarhus N, Denmark; Department of Urology, Aarhus University Hospital, Aarhus N, Denmark.
J Pediatr Urol. 2016 Jun;12(3):154.e1-7. doi: 10.1016/j.jpurol.2016.02.006. Epub 2016 Feb 18.
Conventional urodynamics (CU) is a highly standardized evaluation of lower urinary tract function. However, in pediatric patients there is concern that the reliability of measurements could be influenced by development effects and measurement variability, as well as by the unfamiliar clinical environment. Ambulatory urodynamics (AU) provides an alternative to this - it uses natural filling, is measured over a prolonged period, and is conducted in a child-friendly environment.
The aim of this study was to conduct a comparative analysis of AU and CU to evaluate the consistency in voiding patterns obtained with these two methods of urodynamic testing.
Urodynamic parameters obtained by AU and CU methods in 50 pediatric patients aged >5 years were retrospectively analyzed. Voiding patterns were categorized into six types: coordinated contraction, detrusor after-contraction, fluctuated contraction, pre-void contraction, relief voiding, and weak or absent contraction. Voiding patterns were used to determine the repeatability within urodynamic tests and to identify consistency between AU and CU tests. Five urodynamic parameters were quantified and compared between AU and CU: voided volume, flow rate, maximum detrusor pressure, and detrusor pressure at peak flow rate. For inter-observer variation analysis, 100 voiding curves were randomly selected and categorized by two independent observers; inter-observer agreement was evaluated using the kappa statistic.
A single pattern of voiding was identified in five patients using AU and 37 using CU. Consistency of a single pattern between AU and CU was identified in three patients, and consistency between a predominant pattern with AU, defined by one type of voiding occurring >50% of one's voids, and a single pattern with CU was identified in 10 patients (summary table). Flow rates were similar between methods; however, higher maximum detrusor pressure and detrusor pressure at peak flow and lower voided volume were recorded with AU.
AU resulted in more diverse voiding patterns. Along with the differences in measured urodynamic parameters challenges the application of findings from one method to form a clinical diagnosis. Furthermore, CU may not be as sensitive as AU to the variability in lower urinary tract pathophysiology.
More diverse voiding patterns were identified in AU compared with CU, with a lack of consistency in identified voiding pattern in both methods. Therefore, the urodynamic findings in children may have to be analyzed in more detail, taking the variations into account.
传统尿动力学（CU）是对下尿路功能进行的高度标准化评估。然而，在儿科患者中，人们担心测量的可靠性可能会受到发育影响和测量变异性的影响，以及不熟悉的临床环境的影响。 便携式尿动力学（AU）提供了一种替代方法 - 它使用自然填充，测量时间较长，并在儿童友好的环境中进行。
本研究旨在对 AU 和 CU 进行比较分析，以评估这两种尿动力学测试方法获得的排尿模式的一致性。
回顾性分析了 50 名年龄> 5 岁的儿科患者的 AU 和 CU 方法获得的尿动力学参数。将排尿模式分为六种类型：协调收缩、逼尿肌后收缩、波动收缩、预排尿收缩、缓解排尿和弱或无收缩。使用排尿模式来确定尿动力学测试中的重复性，并确定 AU 和 CU 测试之间的一致性。定量比较了 AU 和 CU 之间的五种尿动力学参数：排空量、流量、最大逼尿肌压力和最大流量时逼尿肌压力。为了进行观察者间变异分析，随机选择了 100 条排空曲线并由两名独立观察者进行分类；使用kappa 统计评估观察者间一致性。
使用 AU 确定了 5 名患者的单一排尿模式，使用 CU 确定了 37 名患者的单一排尿模式。在 3 名患者中确定了 AU 和 CU 之间的单一模式一致性，在 10 名患者中确定了 AU 定义的主要模式（一种排尿类型发生> 50％）与 CU 的单一模式之间的一致性（汇总表）。方法之间的流量相似；然而，AU 记录的最大逼尿肌压力和最大流量时逼尿肌压力更高，排空量更低。
AU 导致了更多样化的排尿模式。与测量的尿动力学参数差异一起，对下尿路病理生理学变异性的应用形成了挑战。此外，CU 可能不如 AU 敏感，无法检测到下尿路病理生理学的变异性。
与 CU 相比，AU 中确定的排尿模式更多样化，两种方法中确定的排尿模式均缺乏一致性。因此，可能需要更详细地分析儿童的尿动力学发现，并考虑到这些变化。
