Uroflowmetry as a Screening Test for Neurogenic Bladder in Children with Cerebral Palsy

Chang, Su Yeon; Kim, Jang Hwan; Han, Sang Won

Abstract

PURPOSE: It is well known that a high proportion of patients with cerebral palsy have neurogenic bladder. However, cystometry performed to determine the presence and type of neurogenic bladder is an invasive procedure. We evaluated the validity of uroflowmetry and postvoid residual urine volume as a screening tool for neurogenic bladder in children with cerebral palsy.
MATERIALS AND METHODS
34 children with cerebral palsy (range 6-13 years) were randomly selected for this study. Uroflowmetry and residual urine volume were deter mined at least twice in 22 children. Uroflow curve pattern was classified into normal, tower, plateau and staccato type. All patients underwent cystometry with sphincter elec tromyography. We analyzed relationship between the results of uroflowmetry and cystometry.
RESULTS
Of the 34 patients, 23 (67.6%) children displayed upper motor neuron lesion of bladder. 11 (32.4%) had uninhibited contraction, 9 (26.5%) small capacity and con comitant detrusor-external sphincter dyssnergia was found in 3 (8.8%). Of 22 children who performed uroflowmetry, 13 showed abnormality. Staccato, tower, and plateau type of pattern was seen 11 (84.6%), 1 (7.7%), and 1 (7.7%) patient, respectively. The re maining 9 (40.9%) children were normal. Eleven of the 13 children with abnormal uroflow curve on uroflowmetry showed upper motor neuron lesion of bladder. Among 13 children with abnormal cystometric results, 11 reveal abnormal uroflow curves. 2 children (22.2%) displayed upper motor neuron lesion of bladder among the 9 children with normal uroflow curve. So, uroflowmetry reveal sensitivity 84.6%, specificity 77.8% for neurogenic bladder in cerebral palsied children.
CONCLUSIONS
These results show a high rate of neurogenic bladder in children with cerebral palsy as in previous reports. Abnormalities on uroflow curve correlated well with abnormal cystometry findings. We believe that uroflowmetry is a viable noninvasive screening tool for the detection of neurogenic bladder in children with cerebral palsy.