Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study

Introduction: Neuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) ≥ 40 cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.

Aim: To analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).

Methods: Retrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure ≥ 40 cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P < .05.

Results: Fifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P < .05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P = 0.0006), SI (0.755, P = .0001) with a cut-off value of 10,69 and 8 cmH2O·s/cc, respectively. We did not find differences in the diagnostic performance between them (P > .05).

Conclusions: The analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.