Changing Concepts in the Urodynamic Evaluation of Children

Abstract

Urodynamic evaluation was performed in 46 children with myelodysplasia, spinal cord injury, enuresis, postoperative incontinence, sacral agenesis and recurrent urinary tract infection. The basic study consisted of voiding cystourethrography followed by the simultaneous recording of intraabdominal and intravesical pressure with external urethral sphincter electromyography [EMG]. Urethral pressure profile, urinary flow rate and anal sphincter EMG were performed selectively. There was no correlation between the clinical neurological level and the cystometric pattern in patients with spinal cord lesions. Bladder-external sphincter dyssynergia was associated with a high post-void residual urine in children with hypertonic bladders, while in children with hypotonic bladders dyssynergia did not affect the post-void residual. Urinary symptoms bore little relationship to urodynamic findings. A complete evaluation of children who have persistent disturbances of micturition is recommended.