Clinical Utility of the Maximum Area of Detrusor Tracing Measurement in the Urodynamic Studies in Paediatric Population

Autores de IIS La Fe

• José Antonio March Villalba

  Autor

• Adrià Costa Roig

  Autor

• Irene Dieguez Hernandez-Vaquero

  Autor

• Alba Polo Rodrigo

  Autor

• Maria Angeles Conca Baenas

  Autor

• José Luis Ruiz Cerdá

  Autor

• Agustin Serrano Durba

  Autor

Participantes ajenos a IIS La Fe

• Magdalena-Benedicto R.

Grupos

• Unidad Mixta de Investigación en Nanomedicina y Sensores

Abstract

Introduction: The calculation of continuous measurement of the area under the curve generated by the detrusor pressure tracing is a new promising parameter that may reflect the impairment of the upper urinary tract and renal function. The aim of this study is to analyse the clinical utility of this parameter in paediatric patients with neuropathic lower urinary tract dysfunction (NLUTD). Methods: Retrospective study of urodynamic studies from paediatric patients (<15 years old) between 2011 and 2023. Patients were grouped as functional or neuropathic depending on the underlying condition. Dependent variables: upper Urinary Tract Dilation (UTD), secondary vesicoureteral reflux (VUR), recurring urinary tract infection (UTI) or acute pyelonephritis. Area under the curve of the detrusor pressure tracing was calculated using closed Newton-Cotes methods and then divided based on the achieved bladder capacity obtaining the following indices: Simpson index [SI], trapezoidal index [TI]. Diagnostic performances were assessed using ROC curves. Results: 210 patients were included. 76.2 % (n = 160) had neuropathic bladder. The median age in neurogenic group was 9 (4–12.5) years (p = 0.029). 41 (25,6 %) patients in neurogenic group reported Grade 2–3 UTD (p = 0,012), 30 (18,8 %) presented with II-IV grade VUR and 51 (32 %) suffered from recurring UTI (p = 0.04). There were no differences in DLPP among two groups (p = 0,765). Our proposed indices were higher in neurogenic group (p < 0.05). In the univariate analysis in patients with recurring UTI, UTD Grade 2–3 and VUR, both indices were higher (p < 0.05). The ROC analysis of both indices performed better than the actual. Discussion: In paediatric patients with neuropathic lower urinary tract dysfunction, measuring the area under the curve of the detrusor pressure tracing demonstrated clinical utility. Good diagnostic performance concerning upper urinary tract dilation, vesicoureteral reflux and urinary tract infection was achieved. Both indices performed better than classic parameters such as detrusor leak point pressure. Conclusions: In paediatric patients with lower urinary tract dysfunction, measuring the area under the curve of the detrusor pressure trace demonstrated clinical utility. Both Simpson and Trapezoidal index performed better than classic parameters such as DLPP in relation to vesicoureteral reflux, upper urinary tract dilation, and recurring urinary tract infection in neurogenic patients. © 2025 Elsevier Inc.

Keywords

• Adolescent; Area Under Curve; Child; Child, Preschool; Female; Humans; Male; Pyelonephritis; Retrospective Studies; ROC Curve; Urinary Bladder; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urodynamics; Vesico-Ureteral Reflux; acute pyelonephritis; anatomical variation; area under the curve; Article; bladder capacity; bladder function; bladder pressure; child; clinical assessment; comparative study; controlled study; cross-sectional study; female; follow up; human; intermittent catheterization; lower urinary tract symptom; major clinical study; male; neuropathy; pediatric patient; preschool child; retrospective study; Simpson index; univariate analysis; urinary tract infection; urodynamics; vesicoureteral reflux; adolescent; bladder; diagnosis; etiology; neurogenic bladder; pathophysiology; physiology; pyelonephritis; receiver operating characteristic