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28
TH
CONGRESS OF THE ESPU
S24-9 (P without presentation)
ALTERATION OF AUTONOMIC NERVOUS SYSTEM ACTIVITY
DURING BLADDER FILLING IN CHILDREN WITH SPINA
BIFIDA
Sang Woon KIM
1
, Yong Seung LEE
1
, Sang Won HAN
1
and Young Jae IM
2
1) Yonsei University College of Medicine, Urology, Seoul, REPUBLIC OF KOREA - 2) Seoul National University,
Department of Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
The functional activity of autonomic nervous system in spina bifida has not been well elucidated.
Our objective was to investigate autonomic nervous system activity using heart rate variability
(HRV) in children with spina bifida during bladder filling.
MATERIAL AND METHODS
HRV was assessed during urodynamic study (UDS) in a fixed protocol (P0 : 2 minutes before
start filling; P1 : start of filling-normal desire to void; P2 : P1-end of filling or start of voiding). A total
of 25 HRV and UDS results between May 2015 and July 2016 were reviewed retrospectively.
During the period, children with vesicoureteral reflux who underwent video-urodynamic study was
established as a control group. Children more 4 years old were included for the study. Children
who had voiding symptoms or who were on medication affecting autonomic nervous activity such
as anticholinergics were excluded. Sixteen patients were included finally (9 control, 7 spina bifida).
RESULTS
Time domain parameters at baseline revealed significantly lower RMSSD and pNN50 in children
with spina bifida compared with control (23.46±14.99 vs 50.96±23.53, p=0.018; 4.61±6.58 vs
33.97±22.02, p=0.004, respectively). In frequency domain, high frequency (HF) HRV was signifi-
cantly lower (117.61±117.83 vs 724.43±402.64 , p=0.002) while low frequency (LF) HRV was not
different (p=0.502). The ratio of LF/HF was increased in spina bifida group at baseline (5.43±5.95 vs
1.74±1.79, p=0.098).
During filling phase, the ratio of LF/HF (P0 5.43±5.95 vs P2 4.45±5.36, p=0.090) was reduced in spi-
na bifida while control group showed stable balance (P0 1.79±1.91 vs P2 1.54±1.05, p=0.728). HF
were significantly increased in children with spina bifida (p=0.037).
CONCLUSIONS
Domains representing parasympathetic activity are relatively decreased in children with spina
bifida at baseline. During bladder filling phase, parasympathetic activity was relatively increased
while control group demontrated stable balance of parasymapathetic/sympathetic activity. These
findings may be related to the pathophysiology of neurogenic bladder in spina bifida.