Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India, Rajasthan, 342005.
Pediatr Surg Int. 2024 Apr 29;40(1):114. doi: 10.1007/s00383-024-05696-y.
Spinal dysraphism is the most frequent cause of neurogenic bladder. Urodynamic study (UDS) is an important component of the follow-up of a child with neurogenic bladder. However, it suffers from a lack of widespread availability and is further hampered by technical difficulties and difficulty in its interpretation in children. A neurogenic bladder often appears vertically elongated; only limited and sparse literature is available regarding objectively defining the bladder shape and the urodynamic parameters in the cohort.
This study aimed to investigate the usefulness of the bladder's height-to-width ratio (HWR) on cystogram as a screening tool for identifying "non-physiological" bladder pressures in children with spinal dysraphism. A prospective study was undertaken to evaluate children operated for spinal dysraphism. Cystogram, ultrasonography and UDS evaluation were performed. HWR was calculated by the ratio of the maximum height to the maximum bladder width at maximum cystometric capacity (MCC), where MCC was calculated using standard Koff's formula, given by (age in years + 2) *30 ml in children more than one year and weight *7 ml for infants. The children were categorised into groups based on maximum detrusor pressure (MDP) into two groups (MDP ≥ 30 cmHO and MDP < 30 cmHO). A receiver-operative characteristic curve was constructed to analyse the sensitivity and specificity of HWR in predicting the MDP.
A total of 53 children, operated for spinal dysraphism, met the study criteria during the study period, from March 2021 to September 2022. The median age of children was 4 years (IQR-3-5.5 years). The HWR ratio was compared between the two groups and was significantly higher for the non-physiological pressure bladders than for physiological pressure bladders (mean of 1.55 vs 1.26, p = 0.001). On evaluating the sensitivity and specificity of HWR for discerning children with non-physiological bladder pressures were 87.5% and 48.28%, respectively. The area under the curve (AUC) was 0.781, with a cut-off value of 1.3.
We attempted to evaluate the HWR based on bladder shape objectively. We demonstrated a moderate correlation between the bladder shape and the bladder pressures. An HWR of 1.3 or higher could be significant for identifying a non-physiological bladder storage pressure.
The height to width ratio of the bladder on cystogram is a useful tool as a surrogate marker for non-physiological storage pressures in bladders of children with spinal dysraphism.
脊柱裂是神经源性膀胱最常见的原因。尿动力学研究（UDS）是神经源性膀胱患儿随访的重要组成部分。然而，它的广泛可用性受到限制，并且由于技术困难和儿童解读困难，进一步受到阻碍。神经源性膀胱通常呈垂直拉长状；只有有限的、零星的文献可用于客观定义脊柱裂患儿的膀胱形状和尿动力学参数。
本研究旨在探讨膀胱高度与宽度比（HWR）在膀胱造影中的作用，作为识别脊柱裂儿童“非生理性”膀胱压力的筛查工具。进行了一项前瞻性研究，以评估接受脊柱裂手术的儿童。进行了膀胱造影、超声检查和 UDS 评估。HWR 通过最大膀胱容量（MCC）时最大高度与最大膀胱宽度的比值计算得出，MCC 用标准的 Koff 公式计算，即年龄（岁）+2）*30 ml 用于 1 岁以上儿童，体重 *7 ml 用于婴儿。根据最大逼尿肌压力（MDP）将儿童分为两组（MDP≥30 cmHO 和 MDP<30 cmHO）。构建了受试者工作特征曲线来分析 HWR 预测 MDP 的敏感性和特异性。
在 2021 年 3 月至 2022 年 9 月期间，共有 53 名接受脊柱裂手术的儿童符合研究标准。儿童的中位年龄为 4 岁（IQR-3-5.5 岁）。比较两组之间的 HWR 比值，非生理性压力膀胱的 HWR 比值明显高于生理性压力膀胱（均值 1.55 比 1.26，p=0.001）。评估 HWR 区分非生理性膀胱压力儿童的敏感性和特异性分别为 87.5%和 48.28%。曲线下面积（AUC）为 0.781，截断值为 1.3。
我们试图根据膀胱形状客观地评估 HWR。我们证明了膀胱形状与膀胱压力之间存在中度相关性。HWR 为 1.3 或更高可能对识别非生理性膀胱储存压力具有重要意义。
膀胱造影上的膀胱高度与宽度比是脊柱裂儿童膀胱非生理性储存压力的有用替代标志物。
