Neurogenic bladder monitoring using the cystomanometer and cystoelastometer

Home bladder pressure measurements correlate with urodynamic storage pressures and high-grade hydronephrosis in children with spina bifida

BACKGROUND

Patients with spina bifida are at risk for developing bladder and renal deterioration secondary to increased bladder storage pressures.

OBJECTIVES

To determine the association of home bladder volume and pressure measurements (home manometry) to: 1) detrusor storage pressures on urodynamics (UDS); and 2) the presence of Society of Fetal Urology (SFU) grades 3-4 hydronephrosis on renal bladder ultrasound in patients with spina bifida.

METHODS

Data were prospectively collected on patients with spina bifida and neurogenic bladder requiring clean intermittent catheterization. Patients used a ruler and typical catheterization equipment to measure bladder pressures and volumes at home. Home measurements were compared to UDS detrusor pressures and SFU hydronephrosis grade. Detrusor pressure <20 cm H₂O at 50% maximal cystometric capacity (MCC) on UDS was used as a measure of safe storage pressures on UDS; conversely, detrusor pressure >20 cm H₂O was used a measure to capture both unsafe storage pressures and those with potential for unsafe storage pressures. Receiver-operator characteristic curves and area under curve (AUC) were calculated to depict the association between home manometry variables with detrusor pressures on UDS and SFU grades 3-4 hydronephrosis.

RESULTS

Included were 52 patients with a median age of 10.3 years (interquartile range 6.3-14.4 years). Three home manometry measurements (maximum bladder pressure, bladder pressure at maximum catheterized volume, and mean bladder pressure) > 20 cm H₂O were sensitive for Pdet >20 cm H₂O at 50% MCC. Maximal bladder pressure >20 cm H₂O was the most sensitive among home manometry measures (sensitivity 100%, specificity 70%, AUC 0.92 for Pdet >20 cm H₂O at 50% MCC on UDS; sensitivity 100%, specificity 62%, AUC 0.89 for SFU grade 3-4 hydronephrosis). None of the patients who had maximum home bladder pressure <20 cm H₂O had SFU grades 3-4 hydronephrosis; conversely, individuals with maximal home bladder pressure >20 cm had a wide range of hydronephrosis grades.

CONCLUSION

None of the patients with maximal home bladder pressure <20 cm H₂O had grade 3-4 hydronephrosis. Home measurements of maximal bladder pressure, bladder pressure at maximum catheterized volume and mean bladder pressure of >20 cm H₂O were all sensitive for Pdet >20 cm H₂O at 50% MCC on UDS. Home manometry is an inexpensive and simple technique to identify patients at risk for and to monitor individuals at high risk of upper tract dilation, without incurring significant cost or morbidity.

Pilot study of a home use cystomanometer in patients with a neurogenic bladder

INTRODUCTION

A novel device, the cystomanometer, was developed for home bladder pressure monitoring in patients with neurogenic bladder.

OBJECTIVE

To report initial experience and proof of concept with home use of the cystomanometer.

STUDY DESIGN

Patients were asked to use the device twice daily for two weeks.

RESULTS

Fourteen patients with neurogenic bladder were enrolled.

DISCUSSION

The cystomanometer initially functioned well and transmitted data to a smartphone and to the hospital server. However, over 50% of devices broke.

CONCLUSIONS

We report the first home use of a handheld electronic cystomanometer with wireless data transmission to a smartphone and hospital database.

Non-invasive markers in the management of pediatric neurogenic bladder over the last two decades - A review

Neurogenic bladder (NB) is one of the most challenging problems in nephro-urological management in pediatrics. It is an important risk factor of secondary upper urinary tract damage. A complete clinical evaluation is necessary and requires life-long extensive medical attention including invasive procedures that affect patients' quality of life. Potential non-invasive biomarkers would be desirable, especially in the pediatric population. The aim of this review was to analyze two decades of data regarding potential non-invasive biomarkers in the assessment and follow-up of children with NB. This paper summarizes and appraises the knowledge about both biochemical and imaging-based markers in 3 aspects: markers of urinary tract infections (UTIs), bladder and renal function, and this paper looks at their prospective application in everyday clinical care.