Vaze Poonam Guha, Saha Subhasis, Sinha Rajiv
Department of Pediatric Surgery, AMRI Hospitals, Kolkata, West Bengal, India.
Pediatric Nephrology Division, Department of Pediatrics, Institute of Child Health, Kolkata, West Bengal, India.
J Indian Assoc Pediatr Surg. 2023 Jul-Aug;28(4):282-287. doi: 10.4103/jiaps.jiaps_51_23. Epub 2023 Jul 11.
Invasive urodynamics (UDS) is a standard investigation in children. Studies measuring voiding pressures in children use varied nomenclatures and quote a wide range of voiding pressures. Thus, voiding pressures in children are not considered reliable and they do not find any place in the pediatric diagnostic armamentarium. On the contrary, adult studies have well-defined nomograms and standard values which make voiding studies indispensable in the diagnosis of voiding dysfunctions in adults. The difference primarily lies in the uniformity of parameters assessed in adults and the contrasting heterogeneity in the pediatric literature.
The objective of this study was to study the voiding parameters observed during UDS in boys.
We retrospectively reviewed the pressure flow data obtained during conventional invasive UDS in 106 neurologically normal boys (6 months-16 years) who had different indications for urodynamics. The values of Pdetmax and PdetQmax were analyzed and compared with the existing data of pressure flow studies in children.
Pdetmax decreased with age whereas PdetQmax was independent of age. The difference between the values of Pdetmax and PdetQmax was more in the younger kids. The wide range of voiding detrusor pressure (Pdet) in the existing pediatric literature is similar to the values of Pdetmax observed in our study, whereas the value of PdetQmax is much lower.
The values of Pdetmax observed in this study are similar to the values of "maximum Pdet during voiding" documented in previous studies and are determined by detrusor contractility and functional/dynamic contraction of outflow during voiding. PdetQmax has been documented in very few pediatric studies and is significantly less than Pdetmax. Further prospective studies are needed to corroborate UDS findings with radiologic/cystoscopic findings to create nomograms of voiding parameters in children.
Existing literature on pediatric voiding studies mentions voiding pressures during variable phases of void (usually Pdetmax) and the values have been very heterogeneous, making voiding pressure-flow studies unreliable in children. PdetQmax values are much lower than values quoted as "standard" pressures and are age independent. The use of PdetQmax instead of PdetMax may make voiding pressures in children more reproducible and informative.
侵入性尿动力学检查（UDS）是儿童的一项标准检查。测量儿童排尿压力的研究使用了不同的术语，并引用了广泛的排尿压力范围。因此，儿童的排尿压力被认为不可靠，在儿科诊断手段中没有一席之地。相反，成人研究有明确的列线图和标准值，这使得排尿研究在成人排尿功能障碍的诊断中不可或缺。主要差异在于成人评估参数的一致性以及儿科文献中截然不同的异质性。
本研究的目的是研究男孩在尿动力学检查期间观察到的排尿参数。
我们回顾性分析了106名神经功能正常的男孩（6个月至16岁）在常规侵入性尿动力学检查期间获得的压力流数据，这些男孩有不同的尿动力学检查指征。分析了Pdetmax和PdetQmax的值，并与儿童压力流研究的现有数据进行了比较。
Pdetmax随年龄下降，而PdetQmax与年龄无关。Pdetmax和PdetQmax值在年幼儿童中的差异更大。现有儿科文献中广泛的排尿逼尿肌压力（Pdet）范围与我们研究中观察到的Pdetmax值相似，而PdetQmax值则低得多。
本研究中观察到的Pdetmax值与先前研究中记录的“排尿期间最大Pdet”值相似，并且由排尿期间逼尿肌收缩力和流出道的功能性/动态收缩决定。PdetQmax在很少的儿科研究中有记录，并且明显低于Pdetmax。需要进一步的前瞻性研究来证实尿动力学检查结果与放射学/膀胱镜检查结果，以创建儿童排尿参数的列线图。
关于儿科排尿研究的现有文献提到了排尿不同阶段的排尿压力（通常是Pdetmax），并且这些值非常异质，使得儿童排尿压力流研究不可靠。PdetQmax值远低于作为“标准”压力引用的值，并且与年龄无关。使用PdetQmax而非PdetMax可能会使儿童的排尿压力更具可重复性和信息量。
