Review
Incont Pelvic Floor Dysfunct 2012; 6(1):9-12
Interpretation of Uroflowmetry and Post-Void Residual Urine in Children:
Fundamental Approach to Pediatric Non-neurogenic Voiding Dysfunction
Stephen Shei-Dei Yang, M.D.1,2, I-Ni Chiang, M.D.3,4, Shang-Jen Chang, M.D.1,2
Division of Urology1, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan; Department of Urology2,
School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Division of Urology3, Department of Surgery, Keelung Hospital, Keelung, Taiwan;
Department of Urology4, National Taiwan University Hospital, Taipei, Taiwan
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Parameters generated from uroflowmetry
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Interpreting uroflowmetry
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~åÇ=Öáêäë=~êÉ=~ëâÉÇ=íç=îçáÇ=áå=~=ëáííáåÖ=éçëáíáçåK=dáêäë=áå=~=ëáííáåÖ=éçëáíáçå
~êÉ=~ëâÉÇ=íç=ëáí=ïáíÜ=~ÇÉèì~íÉ=Ñççí=ëìééçêíI=~=ëíê~áÖÜí=Ä~Åâ=~åÇ=~=íáäíÉÇ
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Scale
Received: November 7, 2011 Accepted: November 16, 2011
Address correspondence to: Dr. Shang-Jen Chang, Division of Urology, Department of
Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Road, Xindian,
Taipei, Taiwan
E-mail: [email protected]
Fig. 1.
V
The same figures using different scales.
Review
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Flow
0
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Volume
0
Time
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00:00
Fig. 2.
00:40
00:20
01:00
01:20
Artifact in uroflowmetry curves.
60
Peak flow rate (mL/sec)
50
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10
0
50
100
150
200
250
BC (%EBC)
Fig. 3.
Maximal flow rate initially increases with the volume of urine in the
bladder, then decreases at 150% of expected bladder capacity for age.
mL/s
25
mL/s 25
Flow
Flow
mL
SK=fåíÉêJçÄëÉêîÉê=~ÖêÉÉãÉåí
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0
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mL/s 25
mL/s 25
Flow
Flow
0
mL 1000
0
mL 1000
Fig. 4.
NM
0
mL 500
(A) Tower-shaped curve. (B) Staccato curve. (C) Interrupted curve.
(D) Plateau curve.
Review
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120
100
80
60
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Bladder capacity (%EBC)
Fig. 5.
The post-void residual urine in children is dependent on the bladder
capacity (the volume of urine in the bladder when starting to void/
expected bladder capacity for age).
Indications for invasive urodynamic study (UDS)
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mL
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100
80
60
40
20
0
Void 1
Fig. 6.
Void 2
Great variation in the post-void residual urine in consecutive voidings.
NN
Review
7. Mattsson S, Spangberg A: Urinary flow in healthy schoolchildren.
Neurourol Urodyn 1994; 13:281-296.
8. Gutierrez Segura C: Urine flow in childhood: A study of flow chart
parameters based on 1,361 uroflowmetry tests. J Urol 1997; 157:
1426-1428.
9. Bower WF, Kwok B, Yeung CK: Variability in normative urine flow
rates. J Urol 2004; 171:2657-2659.
10. Chang SJ, Yang SS: Inter-observer and intra-observer agreement
on interpretation of uroflowmetry curves of kindergarten children. J
Pediatr Urol 2008; 4:422-427.
11. Venhola M, Reunanen M, Taskinen S, Lahdes-Vasama T, Uhari M:
Interobserver and intra-observer agreement in interpreting urodynamic measurements in children. J Urol 2003; 169:2344-2346.
12. Gacci M, Del PG, Artibani W, et al: Visual assessment of uroflowmetry curves: Description and interpretation by urodynamists. World
J Urol 2007; 25:333-337.
13. Shand DG, Nimmon CC, O'Grady F, Cattell WR: Relation between
residual urine volume and response to treatment of urinary infection.
Lancet 1970; 760:1305-1306.
14. Shaikh N, Abedin S, Docimo SG: Can ultrasonography or uroflowmetry predict which children with voiding dysfunction will have recurrent urinary tract infections? J Urol 2005; 174:1620-1622.
15. Jansson UB, Hanson M, Sillen U, Hellstrom AL: Voiding pattern
and acquisition of bladder control from birth to age 6 years--a longitudinal study. J Urol 2005; 174:289-293.
16. Erasmie U, Lidefelt KJ: Accuracy of ultrasonic assessment of residual urine in children. Pediatr Radiol 1989; 19:388-390.
17. Drzewiecki BA, Bauer SB: Urodynamic testing in children: Indications, technique, interpretation and significance. J Urol 2011; 186:
1190-1197.
18. Chase J, Austin P, Hoebeke P, McKenna P: The management of
dysfunctional voiding in children: A report from the Standardisation
Committee of the International Children's Continence Society. J Urol
2010; 183:1296-1302.
19. Chang SJ, Yang SS: Non-invasive assessments of pediatric voiding dysfunction. LUTS 2009; 1:63-69.
20. Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J:
One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001; 87:575-580.
21. Kaufman MR, DeMarco RT, Pope JC, et al: High yield of urodynamics performed for refractory nonneurogenic dysfunctional voiding in the pediatric population. J Urol 2006; 176:1835-1837.
Expected results of urodynamic findings
qÜêçìÖÜ=rap=ïáíÜ=çê=ïáíÜçìí=áã~ÖáåÖI=Ää~ÇÇÉê=ÇóëÑìåÅíáçå=Å~å
ÄÉ=ÖêçìéÉÇ=~ë=~=ëíçê~ÖÉ=çê=îçáÇáåÖ=éÜ~ëÉ=éêçÄäÉãK=cêÉèìÉåí=ÑáåÇáåÖë
áå=íÜÉ=ëíçê~ÖÉ=éÜ~ëÉ=áåÅäìÇÉ=ìåëí~ÄäÉ=ÇÉíêìëçê=Åçåíê~ÅíáçåëI=ëã~ää
ÅóëíçãÉíêáÅ=Å~é~Åáíó=~åÇ=éççêäó=Åçãéäá~åí=Ää~ÇÇÉêK=sçáÇáåÖ=éÜ~ëÉ
ÇáëçêÇÉêë=Å~å=ÄÉ=Åä~ëëáÑáÉÇ=áåíç=Çóå~ãáÅ=çê=~å~íçãáÅ~ä=ÇóëÑìåÅíáçåK
aóëÑìåÅíáçå~ä=îçáÇáåÖ=ãÉ~åë=áåíÉêãáííÉåí=ëéÜáåÅíÉêáÅ=Åçåíê~Åíáçåë=çê
ìåJêÉä~ñÉÇ=ëéÜáåÅíÉê=ÇìêáåÖ=ÇÉíêìëçê=Åçåíê~ÅíáçåK=mçëëáÄäÉ=~å~íçãáÅ~ä
çÄëíêìÅíáçåë=áåÅäìÇÉ=Ää~ÇÇÉê=åÉÅâ=ÇóëÑìåÅíáçåI=ÅçåÖÉåáí~ä=éçëíÉêáçê
ìêÉíÜê~ä=ãÉãÄê~åÉI=~åÇ=éçëíÉêáçê=ìêÉíÜê~ä=î~äîÉK=aÉí~áäÉÇ=áåÑçêã~íáçå
çå=íÜÉ=Çá~Öåçëáë=~åÇ=íêÉ~íãÉåí=Å~å=ÄÉ=ÑçìåÇ=áå=ëéÉÅá~äáëí=ÄççâëK
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mÜóëáÅá~å=ÇÉ~äáåÖ=ïáíÜ=éÉÇá~íêáÅ=rqf=~åÇ=äçïÉê=ìêáå~êó=íê~Åí=ÇóëJ
ÑìåÅíáçå=ëÜçìäÇ=ÄÉ=Ñ~ãáäá~ê=ïáíÜ=åçåJáåî~ëáîÉ=ìêçÑäçïãÉíêó=~åÇ=mso
íÉëíë=ïÜáÅÜ=éêçîáÇÉ=î~äì~ÄäÉ=~ëëÉëëãÉåí=çÑ=Ää~ÇÇÉê=ÑìåÅíáçåK=léíáã~ä
Ää~ÇÇÉê=Å~é~ÅáíóI=áKÉK=~=îçáÇÉÇ=îçäìãÉ=ÄÉíïÉÉå=RMB=~åÇ=NMMB=çÑ=íÜÉ
b_`I=áë=êÉèìáêÉÇ=áå=íÜÉ=áåíÉêéêÉí~íáçå=çÑ=ìêçÑäçïãÉíêó=~åÇ=msoK
obcbobk`bp
1. Von Garrelts B: Analysis of micturition; a new method of recording
the voiding of the bladder. Acta Chir Scand 1957; 112:326-340.
2. Neveus T, von Gontard A, Hoebeke P, et al: The standardization of
terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006; 176:314-324.
3. Chang SJ, Yang SS: Variability, related factors and normal reference value of post-void residual urine in healthy kindergarteners. J
Urol 2009; 182(Suppl 4):1933-1938.
4. Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL:
Standardization and definitions in lower urinary tract dysfunction in
children. International Children's Continence Society. Br J Urol 1998;
81(Suppl 3):1-16.
5. Yang SS, Wang CC, Chen YT: Home uroflowmetry for the evaluation of boys with urinary incontinence. J Urol 2003; 169:1505-1507.
6. Yang SS, Chang SJ: The effects of bladder over distention on voiding function in kindergarteners. J Urol 2008; 180:2177-2182.
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