aHt

iFttftaowcpccNid

fpwcssapnpf

CTdorm

R

1

1

1

1

1

EWftmfbmsfvdpcensivntfbl

bsfiiw

CH

dU

U

re smaller than those perceived in daily bladder cycles.owever, because the duration of cystometry is smaller

han a regular bladder cycle, this result is not surprising.Subjectivity may be considered as another potential lim-

tation for methods that depend on patient’s interpretation.or evaluating daily bladder cycles, it will be more valuableo use patient’s own sensations, although they are subjec-ive. However, it might not be reliable to use ND and/or SDor comparing one patient with another. As we reported inhe results section, the ND/SD ratio is a reliable parameternd can be used as the single parameter. For instance, for anverhydrated patient, ND value will be small but SD valueill also be small, so ND/SD ratio will not change. Inontrast, for a dehydrated patient, duration till ND waserceived will be long but duration till SD value was per-eived will also be long; hence, the ND/SD ratio will nothange. No correlation was revealed between cystometricD/SDsec and ND/SDdaily ratios. This means that for an

ndividual patient, cystometric sensations may not representaily bladder perceptions.

Even though cystometry is still the standard methodor determining the lower urinary tract function in manyathologies, its results in perception are not correlatedith our data, which were obtained from daily bladderycles. In contrast, determining bladder perception byensations charts is a new method. This is a preliminarytudy, although not a very strong one, it gives importantnd significant data about the usage of ND/SD as a newarameter to determine daily bladder perceptions as aoninvasive method. However, it is not possible to pro-ose this method for daily practice. It shall be searchedor using as a standard method.

ONCLUSIONShis method of measuring sensations was reproducibleuring 3 days and they did not correlate with the timingf the sensations during cystometry. Further studies areequired to understand which technique can give the trueeasure of the bladders sensory function.

eferences1. Neveus T, von Gontard A, Hoebeke P, et al. The standardization

of terminology of lower urinary tract function in children andadolescents: report from the standardization committee of the In-ternational Children’s Continence Society (ICCS). J Urol. 2006;176:314-324.

2. De Wachter S, Wyndaele JJ. Frequency-volume charts: a tool toevaluate bladder sensation. Neurourol Urodyn. 2003;22:638-642.

3. Erdem E, Akbay E, Doruk E, et al. How reliable are bladderperceptions during cystometry? Neurourol Urodyn. 2004;23(4):306-309.

4. Erdem E, Tunckiran A, Acar D, et al. Is catheter cause of subjec-tivity in sensations perceived during filling cystometry? Urology.2005;66(5):1000-1003.

5. Erdem E, Kanik EA, Ulger S. Comparisons of bladder perceptionsduring cystometry in children and adult patients. Urology. 2009;73:79-82.

6. Finberg L. Water metabolism and regulation. In: Finberg L, Kra-vath RE, Hellerstein S, eds. Water and Electrolytes in Pediatrics,

2nd ed. Philadelphia, PA: WB Saunders; 1992:17-21. I

ROLOGY 75 (1), 2010

7. Chin-Peuckert L, Komlos M, Rennick JE, et al. What is thevariability between 2 consecutive cystometries in the same child?J Urol. 2003;170(4 Pt 2):1614-1617.

8. Lorenzo AJ, Wallis MC, Cook A, et al. What is the variabilityin urodynamic parameters with position change in children?Analysis of a prospectively enrolled cohort. J Urol. 2007;178(6):2567-2570.

9. Chin-Peuckert L, Rennick JE, Jednak R, et al. Should warm infu-sion solution be used for urodynamic studies in children? A pro-spective randomized study. J Urol. 2004;172(4 Pt 2):1657-1661.

0. Joseph DB. The effect of medium-fill and slow-fill saline on detrusorpressure in infants and children with myelodysplasia. J Urol. 1992;147(2):444-446.

1. Yarnitsky D, Vardi Y. Bladder sensory power factor (BSPF): a noveldiagnostic tool. J Neurol Sci. 1993;120(2):137-140.

2. DeWachter S, Wyndaele JJ. Current perception thresholds in thelower urinary tract: sine- and square-wave currents studied in younghealthy volunteers. Neurourol Urodyn. 2005;24(3):261-266.

3. Frimodt-Moller C. A new method for quantitative evaluation ofbladder sensibility. Scand J Urol Nephrol. 1972;6:143-145.

4. Bower WF, Moore KH, Adams RD. A novel clinical evaluation ofchildhood incontinence and urinary urgency. J Urol.2001;166(6):2411-2415.

DITORIAL COMMENThen I evaluate a child with daytime incontinence, parents

requently comment that their child never seems to know wheno urinate until he/she has had an accident. The role of abnor-al sensation in children with incontinence has not been

ocused on nearly as much as other factors. This is partlyecause of its subjective nature as well as the lack of reliableethods to measure it. This manuscript focuses on a noninva-

ive technique to objectively measure the bladder’s sensoryunction. By measuring the time to sensation rather than theolume, more than 1 measurement can be made (ie, normalesire and strong desire) without the child needing to void. Theatients were hydrated by protocol to try creating a relativelyonstant rate of urine production. To further eliminate theffect of variable rates of urine production, the ratio of time oformal desire to strong desire was calculated. The resultshowed that these noninvasive measurements were reproduc-ble over 3 days with good correlation. In comparison witholumes when the sensations occurred during cystometry, theoninvasive measurements did not correlate well. Althoughhis indicates that the time measurements cannot be substitutedor sensations reported during cystometry, they could possiblye a better indicator of bladder sensory function because of theack of the influence of the urethral catheter.

Whether this method of determining bladder perceptionsecomes a useful clinical tool cannot be answered until furthertudies can be done. Perhaps, the use of these parameters inuture studies may provide some insights into sensory problemsn children with daytime incontinence. This technique, whichs a noninvasive and relatively simple, may provide an objectiveay to classify bladder sensation in children with incontinence.

hristopher Austin, M.D., Pediatric Urology, Oregonealth Sciences University, Portland, Oregon

oi:10.1016/j.urology.2009.07.1269ROLOGY 75: 169, 2010. © 2010 Published by Elsevier

nc.

169