The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction
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Purpose of Review
The symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children.
Non-invasive tests such urine studies, uroflowmetry ± simultaneous electromyography, assessment of post-void residual, renal/bladder ultrasound, and pelvic ultrasound when used appropriately can provide valuable information to facilitate decision making during the evaluation of children with LUTD. While these tests should be employed prior to more invasive testing such as urodynamic studies, they can often act as a surrogate for the more invasive tests.
Non-invasive tests can help us in our goal of improving diagnostic ability to better classify the child’s LUTD into an actual condition which allows targeted treatment in the hope of better outcomes and more satisfied patients and families.
KeywordsNon-invasive testing Voiding dysfunction Pediatrics Uroflowmetry with EMG EMG lag time
Compliance with Ethical Standards
Conflict of Interest
Jason P. Van Batavia reports part of his salary supported by the Urology Care Foundation and grant from the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR001879). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Andrew J. Combs declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 4.Silay MS, Aslan AR, Erdem E, Tandogdu Z, Tekgul S. Evaluation of functional lower urinary tract dysfunction in children: are the physicians complying with the current guidelines? SciWorld J. 2013;2013:341606.Google Scholar
- 8.Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2014;191(6):1863–5.e13.CrossRefPubMedGoogle Scholar
- 9.Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006;176(1):314–24.CrossRefPubMedGoogle Scholar
- 16.• Maternik M, Chudzik I, Krzeminska K, Zurowska A. Evaluation of bladder capacity in children with lower urinary tract symptoms: comparison of 48-hour frequency/volume charts and uroflowmetry measurements. J Pediatr Urol. 2016;12(4):214.e1–5. The authors compare the accuracy of 48 hours frequency/volume charts with uroflowmetery with PVR measurements in children with nocturnal enuresis, overactive bladder and dysfuncitonal voiding. While F/V charts were reliable for children with nocturnal enuresis to estimate maximum bladder capacity, both F/V charts and uroflow/PVR data were neeed for children with OAB and DV to accurately evaluate bladder capacity. CrossRefGoogle Scholar
- 18.•• Altan M, Citamak B, Bozaci AC, Mammadov E, Dogan HS, Tekgul S. Is there any difference between questionnaires on pediatric lower urinary tract dysfunction? Urology. 2017;103:204–8. The authors compare the Dysfunctional Voiding Symptom Score [DVSS], the Dysfunctional Voiding and Incontinence Symptom Score [DVISS], and the Incontinence Symptom Index-Pediatric [ISI-P]) in a head-to-head-to-head fashion. While the DVISS had the highest accuracy in terms of diagnosis of children with LUTS versus controls, all 3 questionnaires showed good correlation with parents’ ratings in terms of response to treatment. CrossRefPubMedGoogle Scholar
- 26.• Franco I, Shei-Dei Yang S, Chang SJ, Nussenblatt B, Franco JA. A quantitative approach to the interpretation of uroflowmetry in children. Neurourol Urodyn. 2016;35(7):836–46. The authors describe the development and utility of a reproducible and reilable method to interprete uroflowmetry patterns called the flow index (FI). Based on data from 1,268 healthy children, FI was tested and shown to be statistically robust in predicting uroflow pattenrs – bell, plateau, and tower. CrossRefPubMedGoogle Scholar
- 28.Clothier JC, Wright AJ. Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatric nephrology (Berlin, Germany) 2017.Google Scholar
- 35.Mostafavi SH, Hooman N, Hallaji F, Emami M, Aghelnezhad R, Moradi-Lakeh M, et al. The correlation between bladder volume wall index and the pattern of uroflowmetry/external sphincter electromyography in children with lower urinary tract malfunction. J Pediatr Urol. 2012;8(4):367–74.CrossRefPubMedGoogle Scholar
- 36.• Tangal S, Gokce MI, Ozayar A, Gulpinar B, Haliloglu AH, Burgu B, et al. Evaluation of a new ultrasound measurement tool for the diagnosis of dysfunctional voiding in pediatric population: full/empty bladder wall thickness ratio. Urology. 2014;83(6):1369–72. The authors compared a new ultrasound measurement, the ratio of full to empty bladder wall thickness (F/E BWT) in 198 healhty children and 126 children with dysfucntional voiding. F/E BWT ratios were higher in children with dysfunctional voiding compared with healthy children and thus the authors conclude that this ratio may serve as a non-invasive tool for evaluating lower urinary tract symptoms in children. CrossRefPubMedGoogle Scholar
- 42.Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatric Gastroenterol Nutr. 2006;43(3):e1–13.Google Scholar
- 45.National Collaborating Centre for Ws, Children's H. National Institute for Health and Clinical Excellence: Guidance. Constipation in children and young people: diagnosis and management of idiopathic childhood constipation in primary and secondary care. London: RCOG Press National Collaborating Centre for Women’s and Children’s Health; 2010.Google Scholar