What research is needed to validate new urodynamic methods? ICI-RS2017

A Y-shape connection device for pediatric patients with an indwelling catheter (Dia = 8Fr) during urodynamic studies, especially for filling phase measurements: a single-center prospective study for safety and effectiveness

Introduction

This prospective study aimed to assess the effectiveness of a Y-shape connection device in reducing pain and bleeding in pediatric patients with indwelling catheters during urodynamic studies (UDS), while also obtaining effective results in the filling phase.

Methods

A total of 45 pediatric patients with a mean age of 13 years were included, all of whom underwent both a UDS with the Y-shape connection device (Method A) and a standard UDS procedure (Method B).

Results

The Y-shape connection device demonstrated similar overall urodynamic parameters compared to the standard procedure, while also resulting in significantly less bleeding (P = 0.006) and lower VAS scores during (1.12 ± 0.58 vs. 3.88 ± 1.01, P = 0.001) and after (0.12 ± 0.08 vs 2.91 ± 0.89, P = 0.001) the procedure. No adverse events were reported at the 1-month follow-up.

Discussion

These findings suggest that the Y-shape connection device can effectively reduce pain and bleeding during and after UDS in pediatric patients with indwelling catheters (Dia = 8Fr), while also obtaining effective results in the filling phase. Therefore, this Y-shape connection device has a more significant value for children who require urodynamic studies and place more emphasis on filling phase parameters.

Clinical trial registration

ChiCTR2300068280.

Head-to-head comparison of pressures during full cystometry, with clinical as well as in-depth signal-analysis, of air-filled catheters versus the ICS-standard water-filled catheters

Aims

To compare in vivo differences of two catheter systems for urodynamics to further discover their measurement properties.

Methods

Side‐by‐side catheterization with two catheters for intravesical and abdominal pressure during full cystometry in 36 prospectively recruited patients with analysis of mean and absolute differences at urodynamic events and post hoc in‐depth signal analysis comparing the full pressure traces of both systems.

Results

The mean pressure differences at urodynamic events between air‐filled and water‐filled systems are small, however, with a large variation, without a systematic difference. The majority of the intersystem differences are significantly larger than 5 cmH₂O. Further analysis showed that urodynamic event pressure differences of both systems at the start of the test were carried forward throughout the remainder of the test without subsequent or additional tendency to differ. Post hoc whole test signal analysis with pressures equalized from the first sample shows high cross‐correlation (>0.981) between the pressure signals per location (rectum and bladder) per test and almost zero‐time shift (<0.05 s) of all cystometry pressure samples.

Conclusions

We confirm earlier studies that showed random differences at events between air‐filled and water‐filled pressures during clinical urodynamic testing and confirm that these are intrinsic but not systematic—and still incompletely explained—offset‐baseline differences. We determined on closer full measurement analysis after equalizing, that both systems are similar in displaying urodynamic pressure variations and amplitudes. We also confirm that both systems require awareness of intrinsic measurement properties during urodynamic testing and especially may necessitate adjustment of pressure offsets into a quantitative diagnosis of a urodynamic test.

Usability and safety of the new 5 French air-charged catheter for performing urodynamic studies on pediatric patients

AIMS

To assess the performance and safety of the T-DOC® 5 French air-charged urodynamic catheters in pediatric patients and obtain feedback from providers related to usability performance.

METHODS

Patients ages 12 years and younger undergoing urodynamics were prospectively recruited from two institutions. The T-DOC® 5 French air-charged catheters were used. Issues with catheter placement, adverse events (AEs), and pain scores were assessed. A follow-up telephone call was made to assess for post-urodynamic AEs. Providers completed a clinical user questionnaire. Likert scale was used (1 = most negative and 5 = most positive response) and reported in mean (range).

RESULTS

A total of 28 patients completed the study. The mean age was 55 months (5-130) (10 females, 18 males). One problem was noted with the insertion of an abdominal catheter, secondary to stool impaction. Catheters stayed in place on all subjects, except for one related to patient hyperactivity. There were no AEs during the studies. In total four reported post-urodynamics AEs (one hematochezia, three dysuria). Among nine patients, pain level on the bladder and abdominal insertion was 3.6/10 (0-10) and 3.1/10 (0-10). Five providers completed the questionnaire. The overall ease of use was rated 4.3/5 (3-5). The ease of insertion was 4.1/5 (2-5) and set-up/clean-up time was 4.4/5 (3-5). Tracing stability, subtraction accuracy, and artifact sensitivity were all perceived favorably (respectively 4.8/5 [4-5], 4.6/5 [4-5], and 4.4/5 [4-5]).

CONCLUSIONS

The T-DOC® 5 French air-charged catheter was considered safe and effective in pediatric patients. No AEs occurred during the studies. Providers, using the catheters, reported favorably on catheter usage.

Recent advances in urodynamics in women

Urodynamics is the study of the storage and evacuation of urine from the urinary tract. The aim is to reproduce the patient’s symptoms and provide a pathophysiological explanation for them by identifying all factors that contribute to the lower urinary tract dysfunction, including those that are asymptomatic. Urodynamics consists of various tests, each of which is designed to assess a different aspect of lower urinary tract function. There is a lack of evidence regarding when urodynamics should be used in the non-neurogenic bladder. Some small randomised controlled trials suggest that urodynamics does not alter the outcome of surgery for stress urinary incontinence when compared with office evaluation alone. However, this is widely felt to be inaccurate and many health-care professionals still advocate the use of urodynamics prior to any invasive treatment, especially surgery on the lower urinary tract. There have been few technological advances in urodynamics in recent years. Air-charged rather than fluid-filled catheters were thought to help reduce artefact, but the evidence is unclear, and there is doubt over their accuracy. Ambulatory urodynamics is carried out over a longer period of time, enabling physiological bladder filling, but it remains invasive and artificial. To attempt to replicate symptoms more accurately, there have been efforts to develop wireless devices to measure detrusor pressure directly. These may be promising but are far from suitable in humans at present. Urodynamics continues to provide useful information for assessing lower urinary tract function, but further large studies are required to assess its value and develop innovations to improve the accuracy of the tests and acceptability to patients.