Day-care ultrasound avoids urodynamics

Background: Post-voiding residual urine is a common problem underlying urin ary symptoms in many children often associated with infection. Tertiary ref erral is often made to exclude a neurological aetiology. This review report s the experience of clinician-performed ultrasound examinations in the Day- Care Unit on 50 children during a 9-month period, with various aetiologies of urinary incontinence avoiding urodynamic studies in 34. Methods: From March 1999 tertiary referral patients with urinary incontinen ce with or without infection and secondary referrals not responding to 'sta ndard' management regimes, underwent clinician-performed bladder ultrasound scans in the day-care ward, A standard renal tract ultrasound examination had been reported as normal in 19 patients, In general referral had been ma de to exclude a neuropathic aetiology. In addition 5 patients were studied who were known to have a neurogenic bladder, 3 with an anorectal anomaly, 3 were post cystoplasty and 2 had undergone surgery for ureteric reflux. Results: In 34 patients it was considered that a urodynamic study had been avoided, while in one results from a urodynamic study were refuted. By mean s of directly visualising the bladder on real time scanning, 12 children an d families achieved a significantly better understanding of the relevance o f residual urine in relation to symptoms, or were shown to have normal detr usor function (7), excluding a neuropathic aetiology. The three who had und ergone cystoplasty were shown to have adequate bladder volumes in spite of persisting wetness. Conclusion: Real-time ultrasound examination of the bladder performed by a clinician in a patient-friendly environment (day-care ward) can provide sig nificant information regarding detrusor function, often avoiding urodynamic studies, The test does not replace formal scanning for anomalies but may p rovide information that is masked by the more rigid environment of a radiol ogy department, sometimes correcting results from standard urodynamic studi es.