CONTINUOUS (6 HOUR) URODYNAMIC MONITORING IN CHILDREN WITH NEUROPATHIC BLADDER

In adults the development of modem equipment for ambulatory monitoring permits long-term evaluation of the lower urinary tract which is more accurate than standard urodynamics (SUD). In children continuous urod ynamic monitoring (CUM) has been used infrequently and therefore stand ardisation of the method has not been previously achieved, nor have th e techniques and difficulties of performing 24-hour monitoring been so lved. The aim of this study was to identify a technical method of CUM in children which was feasible and to verify its usefulness. For this purpose, we reviewed our preliminary experiences of CUM in children wi th neuropathic bladder. From March to November 1995 we made an outpati ent study of the neuropathic bladders of 11 myelodysplastic children a ged 1 to 18 years (average age 10.2 years). 7 of them were males and 4 females. All underwent SUD. With the children resting in bed, a 6-hou r CUM (Lectromed MPR-2) was performed using a 4 Fr microtip intravesic al catheter (suprapubic in 3 infants and transurethral in 8 children) and an intrarectal catheter. The parents and/or a nurse monitored the fluid intake and micturition events and recorded the data in a diary. Based on the CUM experience in infants with non-neurogenic bladder dys function, the 3 suprapubic studies were done after 12 hours of urethra l drainage in order to prevent leakage of urine. In all of the patient s we were able to study 2 to 4 bladder fillings during a period of 6 t o 8 hours (average 6.5 hours) observation. In 9 of the 11 children the CUM pattern was comparable to the SUD one but in the 2 remaining pati ents CUM showed uninhibited contractions. Higher uninhibited voiding c ontraction pressures were recorded in hyper-reflexic bladders. Our pre liminary results show that it is feasible to perform CUM in children a nd that it has advantages over standard cystometry in the investigatio n of children with neuropathic bladder even if it is carried out for s hort term (6 hours).