ESPN 50th Annual Meeting

ESPN 2017


 
PROPER VOIDING OBSERVATION WE CAN EXCLUDE A LOT OF EXPENSIVE AND TIME CONSUMING EXAMINATIONS
VALBONA STAVILECI 1 Destan Kryeziu 2 Diamant Shtiza 3 Irena Palloshi 3 Sadik Llullaku 2 Myrvete Sopi 2

1- UNIVERSITY CLINICAL CENTRE OF KOSOVA, PEDIATRIC CLINIC
2- University Clinical Center of Kosova Urology Clnic
3- University Clinical Center of Tirana
 
Introduction:

In children with voiding dysfunction improper bladder emptying contributes to recurrent urinary tract infections and progressive renal scarring.

Material and methods:

Case presentation of a adolescent girl with Recurrent urinary tract infections. On examination: dysraphismus with spinal nevus. No walking or other neurological deficits.

 

Ultrasound: kidneys normal, bladder large and large amount of residuals, which can’t be emptied after double voiding. Urine: pathologic usually, and urine pH is 7.0, even without UTI; Labs: normal values.  

Results:

Uroflow: On presentation: intermittent curve, >800 ml urine, >200 ml residuals, voiding time>40sec, max flow 30 ml/sec;.    

Lumbosacral MRI normal.  

Cystometry: increased compliance 655ml, no involuntary contractions, stress test negative. Voiding phase: low bladder contractions, max flow 14ml, intermittent curve, and with residuals 50 ml.

Voiding Observation: first observations were not done properly, what made us to go further with examinations. And after the examinations we did observation again at the clinic and resulted: voiding around 4L of urine and drinks large amount >5L. Voiding frequency was normal, no wetting incidents. By thirst and dessmopresin test, which resulted good kidney concentration ability, we excluded insipid diabetes. Conclusion was: Polyuria after polidypsia. 

We recommended limiting liquid intake and regular bladder emptying every 4-6 hours, with double voiding and with regular bowel regime. And the results were good so far, no infections, urine pH <6, and no residuals after 1 year fellow up. Bladder wall was thinner, also.

Conclusions:

Increased residual urine on post-void ultrasound increases the risk of UTI recurrence in children with voiding dysfunction. This residual can be as a consequence of increased intake, also. Because of increased voiding frequency needs attempts to avoid voiding voluntary. This continuously increase bladder capacity.

 

Thus, voiding and defecation history, physical examination, voiding frequency charts and defecation diaries are all essential parts of urodynamics and urologic examination.