Micturition Studies in Infants and Children: Urodynamics in Boys with Disorders of the Lower Urinary Tract

Gierup, J; Ericsson, N. O.

doi:10.3109/00365597109133566

Cited by 24 publications

(6 citation statements)

References 15 publications

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“…In paediatric urology A‐Cs are seldom mentioned. Gierup and Ericsson [15] found a lower incidence of A‐Cs in 42 boys with BOO than in a control group. Hjälmås used urodynamic studies in 47 children with normal lower urinary tracts, and confirmed the observations obtained in adults [8].…”

Section: Discussionmentioning

confidence: 99%

“…All records selected for analysis showed 'tower' or bell-shaped smooth flowmetry patterns, maximum flow rates within the limits of the Gierup nomograms [5] and a detrusor voiding pressure of <70 cmH 2 O. In 131 of the 315 patients initially selected the intravesical pressure curve showed evidence of catheter obstruction (116) or artefacts caused by the child's restlessness (15). In the remaining 184 patients (86 girls consulting for UTI, and 38 girls and 60 boys with enuresis) the final phase of micturition was analysed satisfactorily.…”

Section: Introductionmentioning

confidence: 99%

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Detrusor after‐contractions in children with normal urinary tracts

2002

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Objective To assess the clinical significance of aftercontractions (A-Cs) in children with normal urinary tracts. Patients and methods Urodynamic records obtained in 315 children with urinary infection or enuresis were reviewed retrospectively; 184 were selected for analysis of A-Cs. All patients had normal urinary tracts and none showed signs of an overt neuropathy. The urodynamic method comprised standard measurements of pressures and flowmetry (42 had video-urodynamic studies). Results After-contractions occurred in 151 of the 184 patients; the incidence tended to decrease with age. The mean amplitude of the A-Cs was 77.9 cmH 2 O; in 36% of the records it was higher than the voiding contraction. Residual urine was found in 12 of 151 records with A-Cs, but in only one patient was such residual urine confirmed in control voids. The patterns were assessed in 131 patients: in 36% they resembled stop-test responses, in 31% they were preceded by brief peaks of pressure or had jagged limbs, and in 33% they were grossly irregular. In 137 records the content of the bladder was estimated at the start of A-Cs; in 51% the bladder was empty or had evacuated >95% of its content, in 39% 95-80% and in 10% <80%. In only 7% of the patients had the A-Cs started after the voiding contraction had completely subsided. There was no difference in the incidence of A-Cs in girls with enuresis (84%) and girls with a history of urinary infections (85%). Detrusor instability was detected in 81% of the children with A-Cs and in 70% of those without; there was no correlation between the amplitudes of uninhibited detrusor contractions and of A-Cs. Characteristic images of external sphincter activity were found in only three of 14 video-urodynamic recordings with A-Cs. Conclusions After-contractions are common in children with normal urinary tracts but they tend to disappear with age. In clinical urodynamics they are of limited practical use because their appearance is unpredictable and there are artefacts related to recording the final phase of micturition. The relationship with detrusor instability may be explained as a coincidence of two common but unrelated findings, and A-Cs are unrelated to urinary infection. External sphincter activity is not the only cause of A-Cs and when it occurs it does not alter the course of voiding, as it does in neuropathic dysfunctions. As their clinical significance is uncertain, treatment of A-Cs is not advocated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detrusor after‐contractions in children with normal urinary tracts

2002

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“…The aetiology of bladder neck obstruction is obscure. It has been reported in children (Gierup and Ericsson, 1971) using objective urodynamic criteria and the condition is certainly seen in patients during their late teens. It is most often seen to cause outflow obstruction as a distinct entity during middle age but rarely occurs in women (Turner -Warwick et al, 1973), presumably because their urethral sphincters do not have any specialised reproductive function.…”

Section: Discussionmentioning

confidence: 93%

The Structure of the Bladder Neck in Male Bladder Neck Obstruction

Booth

Shah

Milroy

et al. 1983

British Journal of Urology

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A light microscope and neurohistochemical study is presented of full thickness biopsies from the bladder neck of 10 middle-aged males with urodynamically proven bladder neck obstruction. Apart from varying degrees of collagen deposition in seven cases, no abnormality was present in the detrusor and pre-prostatic components of the bladder neck muscles or in the distribution of cholinergic nerve fibres. The normal noradrenergic innervation to the pre-prostatic sphincter was absent in all specimens; this may be age-related.

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“…Apart from our own brief presentation of three cases (Gierup & Ericsson, 1971), we have been unable to find any reports on the urodynamics in patients with urethral diverticula.…”

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confidence: 86%