Van Batavia Jason P, Fischer Katherine, Moran Monica, Kerr Joy, Messina Adriana, McClatchy Keely, Berry Amanda, Weiss Dana, Long Christopher, Zderic Stephen A
Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Pediatr Urol. 2025 Apr;21(2):276-282. doi: 10.1016/j.jpurol.2024.05.018. Epub 2024 May 25.
Bladder dysfunction, or more specifically lower urinary tract dysfunction (LUTD), remains a common reason for pediatric urology consultation, and the management of these patients is time consuming and frustrating for patients, families and providers alike. But what happens when the patient proves refractory to current treatment modalities? Is there a role for the use of videourodynamics (VUDS) to help guide therapy in the patient with refractory voiding dysfunction, and if so how might we select patients for this invasive study in order to increase the yield of useful information?
To determine the role, if any, for VUDS in the evaluation of pediatric patients with refractory LUTD and to identify parameters that might be used to select patients for this invasive study in order to increase the yield of useful information.
Through our IRB-approved prospectively maintained urodynamics database, we retrospectively identified 110 patients with non-neurogenic LUTD over a period from 2015 to 2022 who underwent VUDS. We excluded patients with known neurologic or anatomic lesions and developmental delay.
There were 76 females and 34 males (69%/31%) and their average age at the time of the study was 10.5 years ± 4 with a median age of 7.3 years. Patients had been followed for a mean of 5.9 ± 3.5 office visits prior to obtaining the VUDS and reported a mean Dysfunction Voiding and Incontinence Symptom Score (DVISS) of 15.6 ± 6.7 before the VUDS. VUDS resulted in a change in management in 86 of these 110 patients (78%). Management changes included a change in medication (53/110), consideration of CIC (11/110), PTENS (1/110) and surgery (14/110). As shown in the Figure, the DVISS score was significantly higher and the number of office visits prior to VUDS was significantly higher in the 86 patients whose management was changed versus the 24 patients in whom management did not change (P < 0.02).
This retrospective analysis suggests that criteria for selecting these patients include: 1) long standing urinary incontinence that is refractory to biofeedback and medications, 2) ≥6 visits to LUTD clinic with no improvement, and 3) LUT symptom score of ≥16. Our findings suggest these criteria identify a cohort of patients in which a VUDS evaluation for the child with refractory LUTD can offer a more exact diagnosis that can shape management.
膀胱功能障碍，或者更具体地说是下尿路功能障碍（LUTD），仍然是小儿泌尿外科会诊的常见原因，对这些患者的管理对于患者、家庭和医疗服务提供者来说都既耗时又令人沮丧。但是，如果患者对当前的治疗方式无效会怎样呢？对于难治性排尿功能障碍的患者，视频尿动力学检查（VUDS）在指导治疗中是否有作用？如果有，我们如何选择患者进行这项侵入性检查，以提高有用信息的产出？
确定VUDS在评估难治性LUTD的小儿患者中的作用（如果有），并确定可用于选择患者进行这项侵入性检查的参数，以提高有用信息的产出。
通过我们经机构审查委员会（IRB）批准的前瞻性维护的尿动力学数据库，我们回顾性地确定了2015年至2022年期间110例接受VUDS检查的非神经源性LUTD患者。我们排除了已知有神经或解剖病变以及发育迟缓的患者。
有76名女性和34名男性（69%/31%），研究时他们的平均年龄为10.5岁±4岁，中位年龄为7.3岁。在进行VUDS检查之前，患者平均接受了5.9±3.5次门诊随访，VUDS检查前报告的平均排尿功能障碍和失禁症状评分（DVISS）为15.6±6.7。在这110例患者中，86例（78%）的管理因VUDS检查而发生了改变。管理改变包括药物调整（53/110）、考虑间歇性导尿（CIC）（11/110）、经皮胫神经电刺激（PTENS）（1/110）和手术（14/110）。如图所示，与管理未改变的24例患者相比，管理发生改变的86例患者的DVISS评分显著更高，且在VUDS检查前的门诊随访次数也显著更多（P<0.02）。
这项回顾性分析表明，选择这些患者的标准包括：1）对生物反馈和药物治疗无效的长期尿失禁；2）≥6次就诊于LUTD门诊但无改善；3）LUT症状评分≥16。我们的研究结果表明，这些标准确定了一组患者，对于难治性LUTD儿童进行VUDS评估可以提供更准确的诊断，从而指导管理。
