Does Pelvic Floor EMG Activity Matter In The Creation Of Nomograms And Flow Equations In Adolescent?
Jose Netto, MD Ph.D1, Adam Hittelman, MD, Ph.D2, Israel Franco, MD2.
1Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil, 2Yale University, New Haven, CT, USA.
INTRODUCTION: A bell shaped flow curve has been designated to represent normal voiders. It is taken for granted that if a child does not have LUTS and voids with a bell curve that this is a normal void irrespective whether the pelvic floor EMG (PFEMG) is quiet. To our knowledge most uroflow nomograms have been created with uroflows that were performed without considering PFEMG. Our hypothesis is that there is a difference in the flow characteristics of patients with bell shaped curves with a quiet pelvic floor emg and those who have emg activity.
METHODS: A total of 1523 urine flow curves were evaluated. After evaluation by two experienced pediatric urologist, only continuous bell-shaped curves, with voided volume (VV) > 50 ml, post voided residue (PVR) < 20 ml, total bladder capacity smaller < 115% of estimated bladder capacity, and Qmax flow index (FI) between 0.74 and 1.25 in adolescents between 12 and 20 years of age were included. 385 girls and 87 boys met the criteria. The flows were grouped into those with and those without PFEMG activity for comparison of flow parameters. Student's t-test and Mann-Whitney analysis were used for comparison of groups. A 95% confidence interval was used for significance.
RESULTS: The mean age was 14.8 ± 2.9 years for girls and 15.2±2.6 for boys and was similar between groups. For girls, there was no difference in Qmax (p=0.534) and Time to Qmax (p=0.825). A significant difference was observed in Qave (p=0.014) and PVR (p<0.012), with those presenting PFEMG activity having lower Qave and PVR. Qmax FI was higher in those with PFEMG activity (p<0.001), while Qave FI was similar (p= 0.073). Adolescents boys did not present a statistically significant difference between Qmax, Qavg, TTQmax, VV, PVR, QmaxFI and QavgFI. When lag time was measured, there was a difference in the observed age (15.06 vs. 17.21 p <0.007) with older patients with longer lag times. All other parameters did not show differences.
CONCLUSION: The data presented here demonstrate that the use of pelvic floor EMG is important in the development of nomograms and standardization of parameters to define normal urination in all female patients. Female adolescents with continuous flow have higher Qave and smaller volumes, and high QmaxFI if they have PFEMG activity, which may be explained by external sphincter dyssynergia, which may not be recognized if PFEMG is not obtained. Unlike females, there was no difference in flow characteristics for males' with bell curves whether there was emg activity present or not.
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