Comparison of “Easy urodynamic study” and Standard urodynamic study in measuring intravesical pressure.

Viseshsindh W1, Sirisopana K1, Sirisreetreerux P1, Pummangura W1

Research Type

Clinical

Abstract Category

Urodynamics

Abstract 718
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Urodynamics Techniques Detrusor Overactivity Prevention
1. Ramathibodi hospital, Mahidol university
Links

Abstract

Hypothesis / aims of study
Urodynamics (UD) are the gold standard for the evaluation of the lower urinary tract and guide to the treatment of neurogenic bladder patients to maintain detrusor pressure below the safety limit. However, the problems of the standard UD are time and money consuming. We hypothesized that the easy UD could be used to accurately measure bladder pressure (Pves) and identify patients at risk of upper tract deterioration who may benefit from early standard UD re-evaluation. Aim of this study is to assess correlation between easy UD and standard UD measurement and identify cut-off value to undergo early standard UD.
Study design, materials and methods
Patients who scheduled for standard UD were recruited for easy UD in order to record intravesical pressure (SPves), intraabdominal pressure (SPabd), detrusor pressure (SPdet) and intravesical pressure by easy UD (EPves) were recorded at maximal cystometric capacity. To ensure consistent results, all patients were instructed to be completely relaxed in a supine position. After finish the filling phase of standard UD the feeding tube was connected to the catheter and hold the end of the catheter upward, making it perpendicular to the abdomen, ensuring the urine would not spill out. Then the level of urine in the feeding tube was measured where the zero was level with the urethral meatus in females and the penoscrotal junction in males. The height of the column of urine was recorded in centimeter.Descriptive study, correlation value and significance of data were analysed.
Results
A total of 20 patients (7 male, 13 female) with mean age of 10 years. Easy UD Pves were correlated with standard UD Pves (P value = 0.4545). No significant relationship between BMI and Pabd (P value = 0.768). By using a value easy UD Pves (ROC area = 1.0) for predict standard UD Pdet > 30 cmH2O, the most reliable value of Easy UD Pves cut-off ≥ 42.5 cmH2O with a sensitivity of 100% and a specificity of 100%.
Interpretation of results
Patients with neurogenic bladder are at risk for increased bladder pressure, which is associated with upper urinary tract and bladder deterioration. Easy UD Pves cut-off ≥ 42.5 cmH2O were associated with at risk of upper tract deterioration (Standard UD Pdet ≥ 30 cmH2O), with a sensitivity of 100% and a specificity of 100%. By using easy UD, we were able to show that patients with pressure measurements greater than 42.5 cm water at maximum recorded volume were at increased risk for hostile bladder.
Concluding message
In this study, we evaluated whether intravesical pressure readings by easy UD comparable to standard UD equipment. The results suggest that the easy UD could be used to measure bladder pressure (Pves) similarly to standard UD and EPves cut-off  ≥ 42.5 cmH2O can help identify patients with risk for upper tract deterioration (SPdet ≥ 30 cmH2O) who may benefit from early standard UD re-evaluation and closer follow-up. This study supports the use of easy UD on its own as an accurate hand-held ambulatory intravesical pressure measurement method. The Easy UD will be a valuable tool in the management of patients with neurologic who are at risk of upper tract deterioration in the out-patient clinic or in the home environment.
References
  1. Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188:2464–2472.
  2. Verpoorten C, Buyse GM. The neurogenic bladder: medical treatment. Pediatr Nephrol. 2008;23:717–725.
  3. Bauer SB, Joseph DB. Management of the obstructed urinary tract associated with neurogenic bladder dysfunction. Urol Clin North Am. 1990;17:395–406
Disclosures
Funding No Clinical Trial No Subjects Human Ethics Committee Ramathibodi Hospital, Mahidol University Helsinki Yes Informed Consent Yes
27/03/2024 16:13:53