The relevance of urodynamic studies for Urge syndrome and dysfunctional voiding: a multicenter controlled trial in children.
OBJECTIVE
The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome.


METHODS
In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment.


RESULTS
In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome.


CONCLUSIONS
Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.
Bael
An
A
Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium. anbael@attglobal.net
Lax
Hildegard
H
de Jong
Tom P V M
TP
Hoebeke
Piet
P
Nijman
Rien J M
RJ
Sixt
Rune
R
Verhulst
John
J
Hirche
Herbert
H
van Gool
Jan D
JD
D000293:Adolescent; D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D017773:Pelvic Floor / Q000503:physiopathology; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000175:diagnosis* / Q000628:therapy*; D014563:Urodynamics
D008333:Mandelic Acids; C005419:oxybutynin