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Outcome of the bladder cooling test in children with neurogenic bladder dysfunction
Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
1999 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 161, no 1, 254-258 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

We evaluated the diagnostic use of the bladder cooling test in children with neurogenic bladder dysfunction.

Materials and Methods

We performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningocele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapidly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was considered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion.

Results

The bladder cooling test was positive in 37 children younger than 4 years, at which age it is normally positive. The test was negative in only 2 patients, indicating a complete lower motor neuron lesion. It was positive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic bladder dysfunction. Four of the 20 children with a negative test voided normally, while the remainder had no voiding contractions, suggesting a nonfunctional spinal sacral reflex arch to the bladder.

Conclusions

The bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron lesion. It may be used longitudinally to demonstrate changes in bladder function with growth.

Place, publisher, year, edition, pages
1999. Vol. 161, no 1, 254-258 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25255DOI: 10.1016/S0022-5347(01)62125-6Local ID: 9694OAI: oai:DiVA.org:liu-25255DiVA: diva2:245583
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. To void at will: lnvestigation and treatment of children with bladder dysfunction
Open this publication in new window or tab >>To void at will: lnvestigation and treatment of children with bladder dysfunction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Improvements in diagnostic and treatment procedures have made it possible to obtain a normal kidney function and continence for most children with bladder dysfunction. However, in the daily clinical work further diagnostic and treatments procedures may be required when traditional methods fail to help the child. The aims of the present studies were to evaluate such diagnostic and treatments alternatives.

A 4-hours observation test of voiding pattern was evaluated in 50 healthy newborns, as reference values were lacking for this age group. Normal values for voiding frequency, intervals, volume and residual urine were established. All parameters varied greatly both inter- and intraindividually. Residual urine occurred after some voidings in most newborns.

At our clinic, children are catheterised without anaesthesia or sedation, following a special concept of preparation. When evaluating this routine most children (93/99) tolerated the procedure well. Five girls and one boy (or their parents) reported the catheterisation to be "very painful", without requiring that the procedure was interrupted.

The diagnostic value of the bladder cooling tests (BCT) was evaluated in 108 children with neurogenic bladder dysfunction. The BCT could identify a functional sacral reflex arch in children without voiding contractions or confirm a suspected lower motor neurone lesion. A positive test in children older than 6 years verified the diagnosis neurogenic bladder dysfunction.

The effect of anogenital afferent stimulation (AGAS) was retrospectively evaluated in 48 children with therapy resistant urge incontinence. Thirty-eight percent were cured, another 15 % improved. AGAS is a useful, potentially curative treatment in children with severe urge incontinence.

Intravesical electrical stimulation (IVES) was offered as alternative treatment to 44 children with bladder emptying problems, 20 of neurogenic origin. Twenty-eight children, 8 with neurogenic problems, had long term normalisation of their voiding and 11/15 children could discontinue clean intermittent catheterisation. IVES seems to be a promising method for treatment of underactive detrusor in children.

Conclusions: Some investigative methods aimed at children with suspected bladder dysfunction were evaluated together with two new treatment modalities involving electrical stimulation of afferent nerve fibres. Anogenital or intravesical electrical stimulation represents alternative options for children with urge incontinence or underactive detrusor when standard treatments fail.

Abstract [sv]

Förbättrad diagnostik och utveckling av nya behandlingmetoder har gjort det möjligt att bevara en normal njurfunktion och kontinens för flertalet barn med blåsstörningar. l det dagliga kliniska arbetet uppkommer emellertid ofta krav utrednings- och behandlingsalternativ när traditionella metoder inte räcker till. Syftet med dessa studier var att utveckla och utvärdera nya diagnostiska och terapeutiska metoder för barn med blåsstörning.

Ett 4-timmars observationstest av miktiansmönstret har utvärderats hos 50 friska nyfödda barn, eftersom referensvärden fattades för denna åldersgrupp. Normalvärden för miktionsfrekvens, intervall, volym och resturin har har tagits fram och visar stora variationer i samtliga miktiansparametrar såväl inter- som intraindividuellt. Flertalet nyfödda barn hade resturin efter någon eller flera miktioner.

Vid PNUT-enheten vid Barn- och ungdomsmedicinska kliniken kateteriseras så gott som samtliga barn transuretra!t utan anestesi eller sedering men efter noggrann förberedelse enligt speciellt program. Vid utvärdering tyckte flertalet (95/99) att konceptet var bra/mycket bra. Fem flickor och en pojke (eller deras föräldrar) tyckte att kateteriseringen gjorde "mycket ont", men utan att kräva att proceduren skulle avbrytas.

Det diagnostiska värdet av köldtest har utvärderats på 108 barn med neurogen blåsrubbning. Köldtestet kunde påvisa en fungerande sakral reflexbåge även hos barn utan miktianskontraktion alternativt bekräfta en misstänkt nedre motorneuronskada. Ett positivt test hos barn äldre än 6 år verifierar diagnosen neurogen blåsrubbning

Effekten av anagenital afferent stimulering (AGAS) har utvärderats retrospektivt hos 48 barn med terapiresistent trängningsinkontinens. Trettiotvå procent blev botade och ytterligare 15 % blev förbättrade. AGAS är en användbar, potentiellt kurativ behandlingsmetod för barn med svår trängningsinkontinens.

lntravesikal elektrisk stimulering (IVES) erbjöds som alternativ behandling till 44 barn med blåstömningsproblem, hos 20 orsakat av neurogena skador. Tjugoåtta barn, 8 med neurogena problem, fick en bestående normalisering av miktionen och 11/15 barn kunde avsluta behandlingen med ren intermittent kateterisering. lVES tycks vara en lovande metod att behandla svag detrusarfunktion hos barn.

Sammanfattning: Olika undersökningmetoder för barn med blåsdysfunktion har utvärderats liksom två nya behandlingsmodeller med elektrisk stimulering av afferenta nervfibrer. Anagenital och intravesikal elektrisk stimulering representerar alternativa möjligheter att behandla barn med trängningsinkontinens respektive svag detrusar när traditionella behandlingmetoder inte hjälper.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 713
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26652 (URN)11217 (Local ID)91-7373-154-4 (ISBN)11217 (Archive number)11217 (OAI)
Public defence
2002-01-11, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-10Bibliographically approved

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Gladh, GunillaLindström, Sivert

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