Abstract：
BACKGROUND: 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?
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：膀胱功能障碍，或更具体地说是下尿路功能障碍（LUTD），仍然是儿科泌尿外科咨询的常见原因，这些病人的管理既费时又让病人感到沮丧，家庭和提供者。但是，当患者证明对当前的治疗方式难以治疗时，会发生什么？使用视频细胞动力学（VUDS）是否可以帮助指导难治性排尿功能障碍患者的治疗，如果是这样，我们如何为这项侵入性研究选择患者以增加有用信息的产量？
目的：为了确定角色，如果有的话,VUDS在难治性LUTD儿科患者的评估中，并确定可用于选择本侵入性研究患者的参数，以增加有用信息的产生。
方法：通过IRB批准的前瞻性尿动力学数据库，我们回顾性分析了2015年至2022年期间接受VUDS的110例非神经源性LUTD患者.我们排除了已知神经或解剖损伤和发育迟缓的患者。
结果：有76名女性和34名男性（69％/31％），他们在研究时的平均年龄为10.5岁±4岁，中位年龄为7.3岁。在获得VUDS之前，对患者进行了平均5.9±3.5次就诊，并报告了VUDS之前的平均功能失调和失禁症状评分（DVISS）为15.6±6.7。VUDS导致这110例患者中有86例（78％）的管理发生变化。管理变化包括药物变化(53/110)，考虑CIC(11/110)，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,86例改变了管理的患者的DVISS评分显著较高,VUDS之前的就诊次数显著较高(P<0.02).
结论：这项回顾性分析表明，选择这些患者的标准包括：1）长期对生物反馈和药物治疗无效的尿失禁，2)LUTD门诊≥6次,无改善,3)LUT症状评分≥16分。我们的发现表明，这些标准确定了一组患者，其中对难治性LUTD儿童的VUDS评估可以提供更准确的诊断，可以形成管理。
目的：为了确定角色，如果有的话,VUDS在难治性LUTD儿科患者的评估中，并确定可用于选择本侵入性研究患者的参数，以增加有用信息的产生。
方法：通过IRB批准的前瞻性尿动力学数据库，我们回顾性分析了2015年至2022年期间接受VUDS的110例非神经源性LUTD患者.我们排除了已知神经或解剖损伤和发育迟缓的患者。
结果：有76名女性和34名男性（69％/31％），他们在研究时的平均年龄为10.5岁±4岁，中位年龄为7.3岁。在获得VUDS之前，对患者进行了平均5.9±3.5次就诊，并报告了VUDS之前的平均功能失调和失禁症状评分（DVISS）为15.6±6.7。VUDS导致这110例患者中有86例（78％）的管理发生变化。管理变化包括药物变化(53/110)，考虑CIC(11/110)，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,86例改变了管理的患者的DVISS评分显著较高,VUDS之前的就诊次数显著较高(P<0.02).
结论：这项回顾性分析表明，选择这些患者的标准包括：1）长期对生物反馈和药物治疗无效的尿失禁，2)LUTD门诊≥6次,无改善,3)LUT症状评分≥16分。我们的发现表明，这些标准确定了一组患者，其中对难治性LUTD儿童的VUDS评估可以提供更准确的诊断，可以形成管理。
