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19–22 APRIL, 2017, BARCELONA, SPAIN
S11-11 (P without presentation)
HOW ACCURATE IS THE DIAGNOSIS OF PRESUMED
IDIOPATHIC OVERACTIVE BLADDER?
Charlotte MELLING
1
, Nicholas WEBB
2
, Michaela BLUNDELL
3
, Paula WILLIAMSON
3
,
Victoria OZKAN
4
, Malcolm LEWIS
2
and Anju GOYAL
1
1) Royal Manchester Children’s Hospital, Department of Paediatric Urology, Liverpool, UNITED KINGDOM - 2) Royal
Manchester Children’s Hospital, Department of Paediatric Nephrology, Manchester, UNITED KINGDOM - 3) University
of Liverpool, Institute for Child Health, Clinical Trials Research Centre, Liverpool, UNITED KINGDOM - 4) The National
Institute for Health Research, Wellcome Trust Clinical Research Facility, Manchester, UNITED KINGDOM
PURPOSE
Diagnosis of Idiopathic Overactive Bladder (IOAB) is based on clinical history and bladder diaries
delineating urgency, frequency, day-time wetting and low voided volumes. Management pathways
include urotherapy and anti-cholinergic treatment. Urodynamic studies are considered much later
in the pathway when there is poor response to treatment. Urodynamic features include detrusor
overactivity, low compliance and small capacity bladder. The aim of this study was to present uro-
dynamic findings in children with refractory urinary incontinence who were diagnosed and managed
as IOAB but were found not to have urodynamic features of idiopathic overactive bladder.
MATERIAL AND METHODS
39 participants with clinical features of IOAB enrolled in a Pilot RCT for IOAB were prospectively
reviewed. Those who did not have urodynamic features of IOAB are included. All participants had
refractory day-time wetting despite anti-cholinergic medication. Suprapubic urodyamics were per-
formed according to ICCS guidelines. Data are described using median and range unless stated
otherwise.
RESULTS
12/39 (31%) children aged 11(7-14) years, did not demonstrate urodynamic features of IOAB. None
of these patients had detrusor overactivity. 75% had larger capacity bladders than expected for
their age. Compliance was 40(11-100) mls/cmH20. Post-void residual volumes were high in 17%
patients.
The results enabled diagnoses of underactive bladder and dysfunctional voiding to be made allow-
ing initiation of appropriate treatment.
CONCLUSIONS
Children managed as IOAB may have other pathologies indistinguishable by their clinical history
and bladder diary alone. Continuation of empirical treatment when there is poor response to man-
agement could risk inappropriate treatment. We recommend that urodynamic assessment should
be contemplated for children with refractory urinary incontinence, at an earlier stage.