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Accuracy of Bladder Capacity Measurements in Children with Bladder Exstrophy Epispadias Complex: Does the Measurement Modality Matter?
Noa Ferziger, BA, Evalynn Vasquez, MD, MBA, Richard Lee, MD, Ted Lee, MD, MSc.
Boston Children's Hospital, Boston, MA, USA.
Background:
Prior to reconstructive surgery to address urinary continence, understanding potential bladder capacity is a key factor in the decision to perform augmentation cystoplasty in patients with bladder exstrophy (BE). To assess bladder capacity in BE, the bladder neck is occluded with a balloon intraoperatively to prevent urine leakage. This study aimed to assess bladder capacity obtained intraoperatively versus those estimated via voiding cystourethrogram (VCUG), urodynamics (cystometrogram), and uroflowmetry. We hypothesized that VCUG, urodynamics, and uroflowmetry would underestimate bladder capacity.
Methods:
A retrospective chart review was conducted of all patients in our institutional bladder exstrophy epispadias complex (BEEC) database who underwent bladder capacity measurement. Every VCUG, urodynamics, and uroflowmetry bladder capacity measurement taken within one year of a cystoscopy was recorded along with that cystoscopy's measured bladder capacity. Statistical analysis was conducted using a linear mixed effects model.
Results:
33 unique patients underwent a cystoscopy and at least one other bladder capacity measurement within the same year. Measurements included 49 cystoscopies, 58 VCUGs, 38 urodynamic studies, and 16 uroflowmetry studies.
Relative to mean bladder volumes measured by cystoscopy, VCUG underestimated capacity by 49ml (Figure 1A, p < .0001), urodynamics underestimated capacity by 63ml (Figure 1B, p < .0001), and uroflowmetry underestimated capacity by 57ml (Figure 1C, p = .001).
Conclusion:
Compared to the gold standard of cystoscopy, VCUG, urodynamics, and uroflowmetry underestimate bladder capacity. Prior to performing continence surgery in BE, surgeons should strongly consider cystoscopy with bladder neck occlusion.
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