Home Bladder Manometry Predicts Urodynamic Intravesical Pressure and Hydronephrosis
Joshua D. Chamberlin, MD, Carol A. Davis-Dao, PhD, Amanda M. Macaraeg, BS, Linda Beqaj, BS, Ahmed Abdelhalim, MD, Ramin Mahmoud, MD, Heidi A. Stephany, MD, Kai-wen Chuang, MD, Irene M. McAleer, MD, Elias J. Wehbi, MD, Antoine E. Khoury, MD.
University of California Irvine, Children's Hospital of Orange County, Orange, CA, USA.
BACKGROUND: Patients with neurogenic bladder are at risk of developing bladder and renal deterioration secondary to increased intravesical pressures. We evaluated the ability of home bladder manometry to identify patients at risk for increased intravesical pressures and progressive hydronephrosis.
METHODS: Data was prospectively collected on patients with spina bifida and neurogenic bladder requiring clean intermittent catheterization. Patients used ruler-based bladder manometry to measure intravesical pressures/volumes at home. Home measurements were compared to urodynamic intravesical pressures and hydronephrosis grade. Elevated urodynamic intravesical pressure was defined as detrusor pressure greater than 20 cm water at 50% urodynamic Maximum Cystometric Capacity (MCC) and detrusor pressure greater than 40 cm water at 85% MCC. Patients with grade IV/V VUR were excluded. ROC curves and AUC were calculated to correlate home manometry variables with elevated urodynamic intravesical pressures and hydronephrosis SFU grade III or IV.
RESULTS: 50 patients were included with mean age of 10.5 years (range 0-21). Home manometry bladder pressures greater than 20 cm water predicted elevated urodynamic detrusor pressures (sensitivity 86%, specificity 81%) and the presence of SFU grade III/IV hydronephrosis (sensitivity 100%, specificity 76%). Based on home manometry, mean bladder pressure and bladder pressure at maximum volume were highly predictive of detrusor pressure at 50% MCC (AUC 0.89 and 0.91), detrusor pressure at 85% MCC (AUC 0.73 and 0.79) and SFU grade III/IV hydronephrosis (AUC 0.93 and 0.92).
CONCLUSIONS: Home manometry bladder pressures strongly correlate with increased intravesical pressures and high-grade hydronephrosis. Home manometry provides an easy screening tool for patients with neurogenic bladder to identify patients requiring more aggressive management, without additional cost or morbidity.
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