ISSN 1683-9803 versão on-line
ARIAS COHL, Santiago, GUGGIARI, Federico e ARIAS, Valentina. Estudio comparativo de las presiones del músculo detrusor en pacientes menores de 19 años, con y sin incontinencia urinaria*. Pediatr. (Asunción), dez. 2006, vol.33, no.2, p.112-117. ISSN 1683-9803.
Introduction: Instability of the detrusor muscle varies between 15% and 97% between children with nocturnal enuresis and children with mixed enuresis. Given its multifactorial nature, it is necessary to have techniques available that determine variation of either intravesical or detrusor pressure in order to determine if the pattern is normal or pathological, and to carry out the appropriate treatment. Objective:The purpose of the study was to determine if the variations if the bladder and detrusor muscle pressure are indicators of urinary incontinence when a comparison is made between patients with and without urinary incontinence. Materials and Methods: We conducted a comparative study of intact groups and one post-testing group made up of two groups of children of both sexes, one with and one without urinary incontinence, who were submitted to provocative filling stimulus at room temperature by slow continuous drip using a two-channel probe. The detrusor and bladder pressure were measured for the purpose of determining if significant differences in pressure would be found between the two groups, thereby confirming the role of higher pressure levels in urinary incontinence. The sample reached the minimum number, 11 cases in each group, to achieve a 95% level of confidence in a one-tailed test. Results: Of the total of 30 patients, 15 in each group, bladder compliance presented a mean of 16.2 + 11.9 cc/cm of water among the incontinent patients and 13.3 + 8.5 among the incontinent patients, with no significant difference (p=0.22) being found. Final detrusor pressure also showed no significant differences in either group (p=0.09) In relation to the maximum detrusor pressure and bladder capacity, it was observed that 10 patients had normal capacity with detrusor pressures below 21 cm of water, these being considered normal, while 12 patients showed pressure above that range; from 21 cm to 40 cm (5 patients), and above 40 cm of water (7 patients). Of the remaining 8 patients, 7 showed reduced capacity, 6 (98.5%) of whom had pressure above 21 cm water, and one had increased capacity with pressure below 21 cm water. Conclusion: In light of the results, the early diagnosis of a normo-, hypo-, or hyper-tonic bladder with normal capacity permits us to predict there is a risk of significant vesicoureteral reflux with possible resulting renal damage in these children.
Palavras-chave: Detrusor; urinary incontinence; urinary bladder; vesicoureteral reflux; diagnosis; pressure.
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