Positional Changes in Voiding Dynamics of Children with Non-Neurogenic Bladder Dysfunction

Ultrasound Urodynamics: A Review of Ultrasound Imaging Techniques for Enhanced Bladder Functional Diagnostics

Purpose of Review

Invasive urodynamics are currently used to diagnose disorders of bladder function. However, due to patient discomfort as well as artifacts induced by catheters and non-physiologic filling, less invasive screening tools that can improve diagnostic information, such as ultrasound are required. The purpose of this review is to assess different modalities of ultrasound as applied to functional bladder imaging. This information will help guide future studies in the use of ultrasound during urodynamics.

Recent Findings

Recently, multiple studies have employed ultrasound to evaluate bladder volume, wall thickness, shape, vibrometry, elastography, compliance, biomechanics, and micromotion during urodynamics. These new techniques have used both 2D and 3D ultrasound techniques to evaluate bladder changes during filling. Continued research is needed to confirm ongoing findings prior to widespread incorporation into clinical practice.

Summary

This review demonstrates the potential use of ultrasound as an adjunct to urodynamics for the diagnostic evaluation of functional bladder disorders.

Does urination position have an effect on evaluation of lower urinary tract function ın children? A uroflowmetric study

Background

We aimed to determine whether different urination positions had significant impact on the parameters of uroflowmetry performed by healthy individuals and children with voiding dysfunction.

Methods

The study was conducted with a prospective and comparative design. Children between 5 and 15 years of age who met the inclusion–exclusion criteria of the study were enrolled. Children in the study were divided into two groups. Participants whose voiding dysfunction symptom score was ≥ 9 points were classified in group 1 and the remaining individuals were classified in group 2. Girls urinated in two different positions as sitting and squatting while boys urinated in three different positions as sitting, squatting and standing. Also, habitual urination position was asked and recorded for each individual participated in the study. Uroflowmetry parameters were compared for different urination positions in two groups separately and a p value of ≤ .05 was accepted for statistical significance.

Results

Voided volume, maximum flow rate (Qmax), time to reach Qmax, urination time and postvoid residual volume measured by abdominal ultrasound were recorded in every participant for each urination position in both groups. In group 1, girls with voiding dysfunction presented a significantly higher postvoid residual volume in squatting position compared to sitting position (the p value = 0.02). In group 2, healthy boys presented a significantly higher Qmax in standing position compared to sitting and squatting positions (the p value = 0.01). All participants provided a better uroflowmetry pattern in their habitual urination positions.

Conclusion

Urination position may affect uroflowmetry results; however, its impact on lower urinary tract function requires further research.

Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?

OBJECTIVE

To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS).

METHODS

Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters.

RESULTS

A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P = .0001).

CONCLUSION

Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.

Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study

OBJECTIVE

The aim was to determine the prevalence of voiding dysfunction and its related risk factors in Turkish schoolchildren.

MATERIALS AND METHODS

A randomly selected, cross-sectional study was conducted using a self-administered and previously validated questionnaire. The questionnaire consisted of two parts. The first part included personal demographic and familial information, and the second part included the Dysfunctional Voiding and Incontinence Scoring System (DVISS). The questionnaires were given to 4668 children between 6 and 15 years of age, which were completed by the parents and children together. The children with a score of ≥9 were accepted as having lower urinary tract dysfunction (LUTD).

RESULTS

The data were collected from 4016 children (the response rate was 86.0%), including 48.6% boys and 51.4% girls. The mean age was 10.5±2.2 years. The overall frequency of LUTD was 9.3%. While the 6-year-old children had the highest frequency (23.1%) of LUTD, this rate was 7.9% at the age of 10, and the children aged 14 years had the lowest frequency (4.9%), (p<0.001). Lower urinary tract symptoms were significantly more common in girls (7.6%) than in boys (3.2%) only for the older age group (between 12 and 15 years of age). Compared with normal children, those with LUTD (with a score of ≥9) had the following risk factors: less educated parents, a parent that had lower urinary tract symptoms when he or she was a child, more persons per room (≥2 persons), more siblings (≥4 siblings) at home, past medical history of urinary tract infections, and squatting position (in girls).

CONCLUSIONS

Lower urinary tract problems are one of the most important and ongoing health problems in childhood. Determining the prevalence of lower urinary tract problems in children and their related risk factors is the first step to managing and reducing the number of children suffering from voiding problems.

Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis

Background

It is suggested that the body posture during urination can influence urodynamic parameters in patients with Lower Urinary Tract Symptoms (LUTS) to an extent approaching pharmacological interventions. In this article, the influence of body position during micturition on maximum urinary flow rate (Qmax), voiding time (TQ) and post-void residual volume (PVR) in healthy males and patients with LUTS is analyzed by means of a systematic review and meta-analysis.

Evidence Acquisition

A systematic search was conducted in 14 medical databases. Studies comparing urodynamic parameters in standing versus sitting position were eligible for inclusion. Studies were stratified according to health status of included male participants: healthy individuals and patients with LUTS. Standardized mean differences for Qmax, TQ and PVR were pooled in a random effects model.

Results

Eleven articles were included. In men with LUTS, a significantly lower PVR (−24.96 ml; 95%CI −48.70 to −1.23) was shown in sitting position compared to standing. In accordance, Qmax was increased (1.23 ml/s; 95%CI −1.02 to 3.48), and TQ was decreased (−0.62 s; 95%CI −1.66 to 0.42) in sitting position, although these differences did not reach statistical significance. In healthy men, Qmax (0.18 ml/s; 95% CI −1.67 to 2.02), TQ (0.49 s; 95%CI −3.30 to 4.27) and PVR (0.43 ml; 95%CI −0.79 to 1,65) were similar in sitting and standing position.

Conclusion

For healthy men, no difference is found in any of the urodynamic parameters. In patients with LUTS, the sitting position is linked with an improved urodynamic profile.

Which voiding position is associated with lowest flow rates in healthy adult men? role of natural voiding position

PURPOSE

To investigate the effect of voiding position on uroflowmetric variables and postvoid residual urine (PVR) volume in healthy adult men without lower urinary tract symptoms (LUTS).

MATERIALS AND METHODS

Men without LUTS were enrolled. Participants were asked to report to the urodynamic suite with comfortably full bladder for uroflowmetry. Each participant performed six voids into digital uroflowmeter (Solar Silver, Medical Measurement System, The Netherlands), all on separate occasions, twice in each of the standing, sitting, and squatting down positions. PVR was measured using transabdominal ultrasound (Siemens).

RESULTS

Total 72 participants were enrolled and 61 completed the study; their mean (+/-SD) age was 26.6 +/- 6.9 years. All of them but one was accustomed to void in standing and squatting positions. The mean maximal flow rates (Q(max)) and average flow rates (Q(ave)) were significantly lower in sitting position, than standing and squatting positions (Q(max): 19.8 +/- 7.4 vs. 23.8 +/- 7.7 and 24.4 +/- 8.1 ml/sec, respectively; P = 0.0001. Q(ave): 11.2 +/- 4.5 vs. 13.9 +/- 4.5, and 13.8 +/- 5.1 ml/sec, respectively; P = 0.0001). The corresponding values of voiding time were significantly higher (t(vv): 38.6 +/- 20.7 sec vs. 28.3 +/- 15.3 and 30.6 +/- 18.1 sec, respectively; P = 0.0001). The latter two positions were statistically similar in voiding characteristics. Voided volumes and PVR were statistically similar among all the three positions.

CONCLUSION

Uroflow parameters were higher in standing and squatting positions compared to sitting in individuals not accustomed to void in sitting position. Therefore, uroflowmetry should not be performed in a position the individual is not familiar with.