02 pediatric uroflowmetry.pdf

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 V Review Recei ved: No vember 7, 201 1 Accept ed: Nov ember 1 6, 201 1 Address correspondence to: Dr. Shang-Jen Chang, Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Road, Xindian, Taipei, Taiwan E-mail: [email protected]  Incont Pelvic Floor Dysfunct 2012; 6(1):9-12 Interpretation of Uroflowmetry and Post-Void Residual Urine in Children: Fundamental Approach to Pediatric Non-neurog enic Voiding Dysfunction Stephen Shei-Dei Yang, M.D. 1,2 , I-Ni Chiang, M.D. 3,4 , Shang-Jen Chang, M.D. 1,2 Division of Urology 1 , Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan; Department of Urology 2 , School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Division of Urology 3 , Department of Surgery, Keelung Hospital, Keelung, Taiwan; Department of Urology 4 , National Taiwan University Hospital, Taipei, Taiwan fkqolar`qflk _ÉÑçêÉ íÜÉ áåíêçÇìÅíáçå çÑ íÜÉ ìêçÑäçïãÉíÉê Äó îçå d~êêÉäíë áå NVRT xNzI ÅäáåáÅá~åë åÉÉÇÉÇ íç ï~íÅÜ íÜÉ é~íáÉåí îçáÇ íç ÇÉíÉêãáåÉ îçáÇáåÖ ÑìåÅíáçåK rêçÑäçïãÉíêó íÉëíë Ãœ~îÉ Ö~áåÉÇ ïáÇÉ ~ÅÅÉéí~åÅÉ ~ë áåáíá~ä ëÅêÉÉåáåÖ íÉëíë Ñçê Éî~äì~íáçå çÑ îçáÇáåÖ ÑìåÅíáçå áå ÅÜáäÇêÉå ÄÉÅ~ìëÉ íÜÉó ~êÉ ëáãéäÉI åçåJáå~î~ëáîÉ ~åÇ êÉä~íáîÉäó áåÉñéÉåëáîÉ xOzK qÜÉëÉ íÉëíë Ã…~Ã¥ ÖáîÉ ÅäìÉë íç íÜÉ ìåÇÉêäóáåÖ ÉíáçäçÖó çÑ îçáÇáåÖ ÇóëÑìåÅíáçå ëáåÅÉ íÜÉ êÉëìäíë ~êÉ ëìãã~êáÉë çÑ çîÉê~ää éÉêÑçêã~åÅÉ çÑ Ää~ÇÇÉê ÅçåJ íê~Åíáäáíó ~åÇ Ää~ÇÇÉê çìíäÉí êÉëáëí~åÅÉK qÜÉ éçëíJîçáÇ êÉëáÇì~ä ìêáåÉ EmsoF áë ÇÉÑáåÉÇ ~ë íÜÉ îçäìãÉ çÑ ìêáåÉ äÉÑí áå íÜÉ Ää~ÇÇÉê ~ÑíÉê îçáÇáåÖK fí ëÉêîÉë ~ë ~ ëáÖå çÑ Ää~ÇÇÉê ÉãéíóáåÖ ~åÇ áë ÅçåëáÇÉêÉÇ ~ êáëâ Ñ~Åíçê Ñçê ÇÉîÉäçéáåÖ ìêáå~êó íê~Åí áåÑÉÅíáçåë ErqfF ~åÇ êÉÅìêêÉåÅÉëK qçÇ~óI íÜÉ mso áë ìëì~ääó ãÉ~ëìêÉÇ ïáíÜ ëìéê~éìÄáÅ ìäíê~ëçìåÇ áåëíÉ~Ç çÑ Å~íÜÉíÉêáò~íáçåK eçïÉîÉêI íÜÉêÉ áë ~ ä~Åâ çÑ åçêçÖê~ãë Ñçê íÜÉ mso áå ÅÜáäÇêÉåK eÉêÉáåI ïÉ áåíêçÇìÅÉ íÜÉ áåÇáÅ~íáçåë ~åÇ íÉÅÜåáèìÉëI ~åÇ Üçï íç áåíÉêéêÉí íÜÉ êÉëìäíë çÑ ìêçÑäçïãÉíêó íÉëíë áå ÅÜáäÇêÉåK rolciltjbqov Indications rêçÑäçïãÉíêó ã~ó ÄÉ ~ééäáÉÇ íç åÉìêçäçÖáÅ~ääó åçêã~ä ÅÜáäÇêÉå ÅÜáäÇêÉå ~ÑíÉê íçáäÉí íê~áåáåÖ çê áå ïÜÉå íÜÉó ~êÉ R óÉ~êë çäÇ áÑ íÜÉó Ãœ~îÉ äçïÉê ìêáå~êó íê~Åí ëóãéíçãëI áKÉK áåÅçåíáåÉåÅÉI ìêÖÉåÅóI çê rqf ~êÉ ëìëéÉÅíÉÇ çÑ îçáÇáåÖ ÇóëÑìåÅíáçåI çê Ãœ~îÉ ëáÖåë ëìÖÖÉëíáîÉ çÑ Ää~ÇÇÉê çìíäÉí çÄëíêìÅíáçåK Techniques qÜÉ ìêçÑäçïãÉíÉê ëÜçìäÇ ÄÉ éä~ÅÉÇ áå ~ èìáÉí ~åÇ éêáî~íÉ éä~ÅÉ ïáíÜ ~ ÅçãÑçêí~ÄäÉ ÉåîáêçåãÉåí ëáåÅÉ ~åñáÉíó ã~ó áãé~áê íÜÉ éÉêÑçêãJ ~åÅÉ çÑ îçáÇáåÖ ÑìåÅíáçå áå ÅÜáäÇêÉåK _ÉÑçêÉ éÉêÑçêãáåÖ ìêçÑäçïãÉíêó íÉëíëI ÅÜáäÇêÉå ~êÉ ~ëâÉÇ íç Çêáåâ ÑäìáÇë ïáíÜ ~ãçìåíë Éèì~ä íç íÜÉ ÉñJ éÉÅíÉÇ Ää~ÇÇÉê Ã…~é~Åáíó Eb_`F áKÉK E~ÖÉ × PM H PMF ãi çåÉ Üçìê ÄÉJ ÑçêÉ íÜÉ íÉëíëK `ÜáäÇêÉå ~êÉ ~ëâÉÇ íç îçáÇ ïÜÉå íÜÉêÉ áë ~ åçêã~ä ÇÉëáêÉ çê ìêÖÉ íç îçáÇK _çóë ~êÉ ~ëâÉÇ íç îçáÇ áå ~ ëí~åÇáåÖ çê ëáííáåÖ éçëáíáçå ~åÇ Öáêäë ~êÉ ~ëâÉÇ íç îçáÇ áå ~ ëáííáåÖ éçëáíáçåK dáêäë áå ~ ëáííáåÖ éçëáíáçå ~êÉ ~ëâÉÇ íç ëáí ïáíÜ ~ÇÉèì~íÉ Ñççí ëìééçêíI ~ ëíê~áÖÜí Ä~Åâ ~åÇ ~ íáäíÉÇ éÉäîáëK ^í äÉ~ëí íïç íÉëíë ~êÉ ìëì~ääó åÉÉÇÉÇ ëáåÅÉ ÜáÖÜ î~êá~Äáäáíó áå ìêçÑäçïãÉíêó íÉëíë ÅçìäÇ äÉ~Ç íç ~ ãáëäÉ~ÇáåÖ Çá~Öåçëáë xPzK qÜÉ fåíÉêJ Ã¥~íáçå~ä `ÜáäÇêÉåDë `çåíáåÉåÅÉ pçÅáÉíó Ef``pF ÇÉÑáåÉë ~ îçáÇÉÇ îçäJ ìãÉ çÑ RM ãi çê ãçêÉ ~ë êÉäÉî~åí Ñçê áåíÉêéêÉí~íáçåë áå ÅÜáäÇêÉå xQzK rêçÑäçïãÉí êó ïáíÜ ~ îçáÇÉÇ îçäìãÉ äÉëë íÜ~Ã¥ RMB çÑ b_` Ãœ~ë î~êá~ÄäÉ ìêçÑäçï é~ííÉêåë xRzK eÉåÅÉI ìêçÑäçïãÉíêó ÅìêîÉë ~êÉ ÄÉííÉê áåíÉêéêÉíÉÇ ïáíÜ ~ îçáÇÉÇ îçäìãÉ ÄÉíïÉÉå RMB ~åÇ NMMB b_` Ñçê ~ÖÉK Parameters generated from uroflowmetry kçêã~ä ìêçÑäçï ÅìêîÉë ëÜçï Åçåíáåìçìë Ñäçï ïáíÜ ÄÉääJëÜ~éÉÇ ÅìêîÉëK qÜÉ Üçêáòçåí~ä äáåÉ çÑ íÜÉ ÅìêîÉ áë íÜÉ íáãÉ áå ëÉÅçåÇë ~åÇ íÜÉ îÉêíáÅ~ä äáåÉ áë íÜÉ Ñäçï ê~íÉ áå ãiLëÉÅK qÜÉ ã~ñáã~ä Ñäçï ê~íÉ Enã~ñF áë ÇÉÑáåÉÇ ~ë íÜÉ éÉ~â Ñäçï ê~íÉ EmcoFK qÜÉ ~êÉ~ ìåÇÉê íÜÉ ÅìêîÉ áë íÜÉ îçáÇÉÇ îçäìãÉK qÜÉ ~îÉê~ÖÉ Ñäçï ê~íÉ áë ÇÉÑáåÉÇ ~ë íÜÉ îçáÇÉÇ îçäìãÉ ÇáîáÇÉÇ Äó íÜÉ îçáÇáåÖ íáãÉK fÑ íÜÉ Ñäçï áë áåíÉêãáííÉåíI íÜÉå íÜÉ Ñäçï íáãÉ áë äÉëë íÜ~Ã¥ íÜÉ îçáÇáåÖ íáãÉK líÜÉêïáëÉ íÜÉ Ñäçï íáãÉ áë Éèì~ä íç íÜÉ îçáÇáåÖ íáãÉK Interpreting uroflowmetry NK _ÉÑçêÉ áåíÉêéêÉíáåÖ ìêçÑäçïãÉíêóI íÜÉ ëÅ~äÉ ëÜçìäÇ ÄÉ ~ÇàìëíÉÇ íç N ãiLëÉÅ çå íÜÉ îÉêíáÅ~ä ~ñáë îÉêëìë N ëÉÅLãi çå íÜÉ Üçêáòçåí~ä ~ñáëK cáÖK N^ ~åÇ N_ ~êÉ íÜÉ ë~ãÉ ÑáÖìêÉë ïáíÜ ÇáÑÑÉêÉåí ëÅ~äÉëK ^äíÜçìÖÜ cáÖK N^ áë ~ ÄÉääJëÜ~éÉÇ ÅìêîÉI cáÖK N_ ã~ó ÄÉ áåíÉêéêÉíÉÇ ~ë ~ éä~íÉ~ì ÅìêîÉK fÃ¥ ~ÇÇáíáçåI áÑ íÜÉêÉ ~êÉ ëÜ~êé éÉ~âë áå íÜÉ Ñäçï ÅìêîÉë EcáÖK OFI ~êíáÑ~Åí áë ÅçåëáÇÉêÉÇ ~åÇ íÜÉ nã~ñ ëÜçìäÇ ÄÉ ÇçÅìãÉåíÉÇ çåäó ~í ~ éÉ~â äÉîÉä ïáíÜ ~ Çìê~íáçå çÑ ~í äÉ~ëí O ëÉÅçåÇëK OK ^ãçåÖ íÜÉ é~ê~ãÉíÉêë ÖÉåÉê~íÉÇ Ñêçã ìêçÑäçïãÉíêó íÉëíëI îçáÇÉÇ îçäìãÉI mco ~åÇ ìêçÑäçï ÅìêîÉë ~êÉ íÜÉ ãçëí áãéçêí~åí é~ê~ãÉíÉêë Fig. 1. The same figures using different scales. Scale

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  • V

    Review

    Received: November 7, 2011 Accepted: November 16, 2011Address correspondence to: Dr. Shang-Jen Chang, Division of Urology, Department ofSurgery, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Road, Xindian,Taipei, TaiwanE-mail: [email protected]

    Incont Pelvic Floor Dysfunct 2012; 6(1):9-12

    Interpretation of Uroflowmetry and Post-Void Residual Urine in Children:

    Fundamental Approach to Pediatric Non-neurogenic Voiding Dysfunction

    Stephen Shei-Dei Yang, M.D.1,2, I-Ni Chiang, M.D.3,4, Shang-Jen Chang, M.D.1,2

    Division of Urology1, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan; Department of Urology2,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Division of Urology3, Department of Surgery, Keelung Hospital, Keelung, Taiwan;Department of Urology4, National Taiwan University Hospital, Taipei, Taiwan

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    Parameters generated from uroflowmetryk~=======J~

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    Interpreting uroflowmetryNK=_==I==~===~==N

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    Fig. 1. The same figures using different scales.

    Scale

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    BC (%EBC)

    Fig. 3. Maximal flow rate initially increases with the volume of urine in thebladder, then decreases at 150% of expected bladder capacity for age.

    Pea

    k flo

    w r

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    (mL/

    sec)

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    10

    050 100 150 200 250

    Fig. 2. Artifact in uroflowmetry curves.

    Artefact

    mL/s 25

    Flow

    0

    mL 500

    Volume

    0Time 00:00 00:20 00:40 01:00 01:20

    Fig. 4. (A) Tower-shaped curve. (B) Staccato curve. (C) Interrupted curve.(D) Plateau curve.

    mL/s 25

    Flow

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    mL/s 25

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    Indications for invasive urodynamic study (UDS)q====rap==~===J=J

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    Fig. 5. The post-void residual urine in children is dependent on the bladdercapacity (the volume of urine in the bladder when starting to void/expected bladder capacity for age).

    Bladder capacity (%EBC)

    Pos

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    al u

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    (mL)

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    mL120

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    Fig. 6. Great variation in the post-void residual urine in consecutive voidings.

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    1. Von Garrelts B: Analysis of micturition; a new method of recordingthe voiding of the bladder. Acta Chir Scand 1957; 112:326-340.

    2. Neveus T, von Gontard A, Hoebeke P, et al: The standardization ofterminology of lower urinary tract function in children and adoles-cents: Report from the Standardisation Committee of the Interna-tional Children's Continence Society. J Urol 2006; 176:314-324.

    3. Chang SJ, Yang SS: Variability, related factors and normal refer-ence value of post-void residual urine in healthy kindergarteners. JUrol 2009; 182(Suppl 4):1933-1938.

    4. Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL:Standardization and definitions in lower urinary tract dysfunction inchildren. International Children's Continence Society. Br J Urol 1998;81(Suppl 3):1-16.

    5. Yang SS, Wang CC, Chen YT: Home uroflowmetry for the evalua-tion of boys with urinary incontinence. J Urol 2003; 169:1505-1507.

    6. Yang SS, Chang SJ: The effects of bladder over distention on void-ing function in kindergarteners. J Urol 2008; 180:2177-2182.

    7. Mattsson S, Spangberg A: Urinary flow in healthy schoolchildren.Neurourol Urodyn 1994; 13:281-296.

    8. Gutierrez Segura C: Urine flow in childhood: A study of flow chartparameters based on 1,361 uroflowmetry tests. J Urol 1997; 157:1426-1428.

    9. Bower WF, Kwok B, Yeung CK: Variability in normative urine flowrates. J Urol 2004; 171:2657-2659.

    10. Chang SJ, Yang SS: Inter-observer and intra-observer agreementon interpretation of uroflowmetry curves of kindergarten children. JPediatr Urol 2008; 4:422-427.

    11. Venhola M, Reunanen M, Taskinen S, Lahdes-Vasama T, Uhari M:Interobserver and intra-observer agreement in interpreting urody-namic measurements in children. J Urol 2003; 169:2344-2346.

    12. Gacci M, Del PG, Artibani W, et al: Visual assessment of uroflow-metry curves: Description and interpretation by urodynamists. WorldJ Urol 2007; 25:333-337.

    13. Shand DG, Nimmon CC, O'Grady F, Cattell WR: Relation betweenresidual urine volume and response to treatment of urinary infection.Lancet 1970; 760:1305-1306.

    14. Shaikh N, Abedin S, Docimo SG: Can ultrasonography or uroflow-metry predict which children with voiding dysfunction will have re-current urinary tract infections? J Urol 2005; 174:1620-1622.

    15. Jansson UB, Hanson M, Sillen U, Hellstrom AL: Voiding patternand acquisition of bladder control from birth to age 6 years--a longi-tudinal study. J Urol 2005; 174:289-293.

    16. Erasmie U, Lidefelt KJ: Accuracy of ultrasonic assessment of re-sidual urine in children. Pediatr Radiol 1989; 19:388-390.

    17. Drzewiecki BA, Bauer SB: Urodynamic testing in children: Indica-tions, technique, interpretation and significance. J Urol 2011; 186:1190-1197.

    18. Chase J, Austin P, Hoebeke P, McKenna P: The management ofdysfunctional voiding in children: A report from the StandardisationCommittee of the International Children's Continence Society. J Urol2010; 183:1296-1302.

    19. Chang SJ, Yang SS: Non-invasive assessments of pediatric void-ing dysfunction. LUTS 2009; 1:63-69.

    20. Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J:One thousand video-urodynamic studies in children with non-neu-rogenic bladder sphincter dysfunction. BJU Int 2001; 87:575-580.

    21. Kaufman MR, DeMarco RT, Pope JC, et al: High yield of urody-namics performed for refractory nonneurogenic dysfunctional void-ing in the pediatric population. J Urol 2006; 176:1835-1837.