Urodinamics in the child’s lower urinary disease

Abstract

Objective: The urodynamics aim is to establish the nature and causes of urinary symptoms at little patient after the vesico-urethral maturation. Material and Methods: During 1996 and 2000 were studied in our center 54 children aged between 4 and 14 years, most of them admitted in «M.S. Curie» Pediatric Hospital from Bucharest. 70% were surgically treated in Center of Urological Surgery, Dialysis and Renal Transplantation (Prof. I. Sinescu) or at the Pediatric Surgical Department (Prof. Pesamosca). The urodynamic studies on children are more complicated than on adults due to the necessity of special equipment, active presence of urodynamic specialist and the pediatric also. Results: The urodynamic disorders' maximum incidence appear after the age of 4 years when the bladder volume is adequate and the neurological center controlled the voluntary urethral sphincter and the detrusor contractility. Therefore, there were identified as causes: persistent urinary infections (80 cases), micturition difficulty or urine loss (60% cases) due to the congenital urinary malformations or neurological diseases (30% cases), sometimes mixed through their complexity (10%). The urodynamic investigation consists on: flowmetry, cystometry, EMG of the pelvic floor, combined studies including micturitional cystography, and in special cases were evaluated the detrusor and the bladder neck, the eventual vesico-ureteral ebb tide or other pathological causes (urethral valves, fisulas, ureterocel, etc). Conclusions: The urodynamic studies on child's persistant urinary disorders are strictly necessary for diagnosis and treatment to follow establishment, especially when there indicated surgical in te rventions are required to correct some complexe urinary and neurologic malformations.