UVA Urology Research Fellow The University of Virginia
Introduction: Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (CeVUS) has been in use to evaluate for genitourinary anomalies but has not been known to be used in conjunction with UDS. We evaluated the ability, quality of using CeVUS UDS and compared the results with fluoro UDS. Methods: Children ages 0-18 were enrolled for CeVUS UDS who previously underwent fluoro UDS. Demographic data, imaging data for CeVUS and fluoro UDS, time in between studies, and clinical data between studies were recorded. Changes in clinical status between the 2 studies included changes in catheterization, urine leakage between, anticholinergic medications, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar’s Chi-Squared and Wilcoxon matched-pairs signed rank test. Results: 53 children were recruited with none declining the study. Table 1 contains demographics and clinical changes between studies. Median time between studies was 1.3 years (IQR 0.9 - 2.9). 53 CeVUS UDS studies were completed with adequate data; none were aborted due to technical reasons. In 4 cases, the bladder neck could not be visualized accurately due to non-mixing and layering of the microbubble contrast against urine (Table 1). Benefits to CeVUS included ability to visualize the exact moment the bladder neck opened. There were no significant differences in bladder shape, presence of vesicoureteral reflux, bladder neck or urethral changes in the cohort at differing time points. Following exclusion of patients with significant changes in medication regimen, catheterization, neuro procedures, hydronephrosis, and UTIs that could lead to changes in UDS imaging findings, a subgroup analysis of 25 patients demonstrated no significant differences in parameters between the 2 studies. Conclusions: CeVUS can be used adequately in conjunction with urodynamics. Slight limitations to CeVUS include more granular imaging for bladder shape compared to fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with CeVUS. SOURCE OF Funding: None.
