Can rectal catheters be avoided during paediatric urodynamic studies?

Abstract

Objective: To determine if the interpretation of urodynamic studies (UDS) in children without a rectal catheter may be similar to multi-channel studies, as UDS in children are challenging and can sometimes be difficult to interpret. Patients and methods: In this retrospective pilot study, 115 paediatric pressure-flow studies were included. A blinded investigator was given two sets of UDS traces. The first set had the vesical trace of all children and the second set had the multi-channel trace. The agreement between the interpretations of both the sets was tested by Cohen's κ, and sensitivity, specificity, and predictive values were expressed with 95% confidence intervals (CIs). The voiding pattern was compared and Pearson's correlation coefficient was used to analyse the pressure at maximum urinary flow (Q max). Results: The most common indications for UDS were neurogenic bladder and posterior urethral valves. The interpretation of compliance and detrusor overactivity by single-channel analysis had a positive predictive value of 92.1% (95% CI 84.7-96.1%) and 89.4% (95% CI 78.3-95.6%), respectively, and a negative predictive value of 100% and 97.1% (95% CI 89.5-99.2%) respectively, in comparison to multi-channel analysis. Children with underactive detrusor were identified reliably by analysing the straining pressure pattern and flow curve. Amongst children who voided, the pressure at Q max showed a moderate correlation (Pearson's coefficient = 0.53) between the two groups. Conclusion: Rectal catheters may be avoided in a carefully selected group of children undergoing UDS who only need filling phase assessment.

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“…For example, Cheriyan et al suggested that the incremental benefit of measuring abdominal pressure may be of questionable value in certain groups of pediatric patients, which could require further investigations by a pediatric urodynamicist. 39 In a retrospective study of 14 patients with neurogenic bladder, Karam et al developed a wavelet-based algorithm to identify bladder events from vesical pressure data alone using a context-aware thresholding algorithm consisting of a novel, tunable, wavelet-based adaptive algorithmic framework. 40 They expanded this method using retrospective urodynamic data from a cat ambulation experiment to predict detrusor pressure using thresholding with a discrete wavelet transformation and filtering using an exponential moving average filter (to remove artifacts and abdominal generated pressure events from vesical pressure) while maintaining representation of detrusor pressure.…”

“…This would have the potential of reducing both patient distress and complexity of the procedure, but may be applicable only for a subset of patients. For example, Cheriyan et al suggested that the incremental benefit of measuring abdominal pressure may be of questionable value in certain groups of pediatric patients, which could require further investigations by a pediatric urodynamicist 39 …”

Re: Can rectal catheters be avoided during paediatric urodynamic studies? By Abhilash Cheriyan, Arun Jacob Philip George, Antony Devasia and J. Chandrasingh

“…And moreover, the authors used pressureflow curves in conjunction with urinary flow curves to determine voiding with straining patterns. The ultimate goal was to determine the feasibility of conducting urodynamic investigations in paediatric populations in the future avoiding the use of a rectal catheter, which adds to the child's distress during the relatively invasive investigation [1]. This has been addressed in previous studies on adult populations [2,3].…”