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Can bladder wall thickness predict the findings of video-urodynamic study in children with spina bifida?
Woojin Kim, MD, Kazuyo Ito, MD, Sayaka Akiyama, MD, Yuichiro Yamazaki, MD.
Kanagawa Children's Medical Center, Yokohama, Japan.

BACKGROUND: Ultrasound measurements of bladder wall thickness (BWT) are currently thought to be potential noninvasive clinical tools for assessing the lower urinary tract. However, there have been few reports regarding the correlation between BWT and urodynamic data in spina bifida patients. In previous reports, when measuring BWT, bladder volume was not specifically defined and had a wide range. BWT is obviously affected by bladder filling volume. Therefore, whether BWT measured at specifically defined bladder volumes is able to predict unfavorable findings on video-urodynamic study (VUDS) in children with spina bifida was investigated.
METHODS: A consecutive series of spina bifida patients with clean intermittent catheterization, who underwent VUDS between September 2012 and October 2013, were prospectively investigated. Ultrasonography was performed simultaneously with VUDS. BWT of the ventral wall was measured at maximum cystometric capacity (MCC), 50%MCC, and 25%MCC. BWT included the mucosa/submucosa, detrusor, and adventitia of the bladder. The analysis was performed in the following two ways:
1) The correlation between BWT measured at MCC and each parameter, including age, MCC, max detrusor pressure (MDP), detrusor leak point pressure (DLPP) and bladder compliance, was estimated.
2) Differences in BWT measured at each percent MCC were compared between patients both with and without unfavorable VUDS findings.
MDP ≥40 cmH2O, DLPP ≥40 cmH2O, bladder compliance < 10 ml/cmH2O, detrusor overactivity (DO), bladder trabeculation and vesicoureteral reflux (VUR) were defined as unfavorable findings on VUDS. VUR was evaluated at MCC.
RESULTS: 1) A total of 53 spina bifida patients (23 males, 30 females; median age, 7.8 years; age range 0.8-21 years) met the inclusion criteria and were measured BWT at MCC. Only age correlated with BWT measured at MCC (p <0.05). No correlation was found among the other parameters.
2) In 31 of 53 patients, BWT was measured at each percent MCC. Concerning unfavorable VUDS findings, no significant differences were recognized in BWT measured at each percent MCC, except for bladder trabeculation (Table). BWT measured at both 50%MCC and MCC were significantly thicker in patients with bladder trabeculation.
CONCLUSIONS: BWT measured at various percent MCC could not predict unfavorable VUDS findings except for bladder trabeculation in children with spina bifida.
Table. Comparison between patients both with and without unfavorable findings on VUDS
Unfavorable findings on VUDSNMean BWT at 25%MCC (mm)p ValueMean BWT at 50%MCC (mm)p ValueMean BWT at MCC (mm)p Value
MDP ≥40cmH2O7/312.50.6532.00.9061.60.739
DLPP ≥40 cmH2O6/212.60.8452.10.9691.70.366
Bladder compliance <10 ml/cmH2O14/312.40.2111.90.2561.60.920
Bladder trabeculation13/312.80.1282.30.0121.80.001

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