A new grading system for evaluation of uroflowmetry-EMG results (Gülhane Grading System)

Year 2021, , 227 - 233, 14.07.2021

Burak Köprü , Giray Ergin , Turgay Ebiloğlu , Bahadır Topuz

https://doi.org/10.38053/acmj.946296

Abstract

Aim: It is recommended that dysfunctional voiding diagnosis should made by the repeated uroflowmetry simultaneously pelvic floor electromyography (UF-EMG) + post void residual measurements. However, there is no evaluation system for UF-EMG parameters regarding the clinical diagnosis, follow up and treatment of these patients. In our study, we aimed to create a new grading system for the diagnosis of dysfunctional voiding by using UF-EMG parameters.
Materia and Method: We have retrospectively obtained UF-EMG and lower urinary tract symptom score results that performed to the children whom applied to our clinic with the symptoms of dysfunctional voiding between 2010 and 2015. A total of 856 reports were included into this retrospective cohort analysis. The proper 610 UF-EMG tests were graded according to our grading system. The UF-EMG grading system is divided into 4 grades: Grade 0: No EMG activity and normal uroflowmetry, Gradenon-EMG: Disturbed flow pattern with no EMG activity, Grade 1: EMG activity with no disturbed flow pattern, Grade 2: EMG activity with minimally disturbed flow pattern, Grade 3: EMG activity with moderately disturbed flow pattern, Grade 4: EMG activity with extremely disturbed flow pattern.
Results: There was no statistically significant difference between the demographic data of patient and control groups (p>0.05). According to grading system, day and nighttime incontinence were statistically significant increases as the grades increases (respectively, p<0,001, p=0,023). According to grading system we created as the grades increased the UF-EMG parameters and the questions of lower urinary tract dysfunction symptom score which evaluated the voiding phase results were statistically significant (p<0.05).
Conclusion: Grading system will be helpful to interpreting the results of the UF-EMG, which considered to be relatively difficult and thus, the diagnosis of the patients can be easier to evaluate and respond to the treatment by urologist.

Keywords

Lower urinary tract dysfunction, Dysfunctional voiding, Uroflowmetry-EMG, Grading system

References

• Wenke S, Van Batavia JP, Combs AJ, Glassberg KI. Analysis of uroflow patterns in children with dysfunctional voiding. J Pediatr Urol 2014; 10: 250-4.
• Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL. Standardization and definitions in lower urinary tract dysfunction in children. International Children’s Continence Society. Br J Urol 1998; 81: 1-16.
• Neveus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006; 176: 314-24.
• Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol 2014; 191: 1863-5.
• Chase J, Austin P, Hoebeke P, McKenna P. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2010; 183: 1296-302.
• Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children’s Continence Society Neurourol Urodyn 2016; 35: 471-81.
• Kajbafzadeh AM, Yazdi CA, Rouhi O, Tajik P, Mohseni P. Uroflowmetry nomogram in Iranian children aged 7 to 14 years. BMC Urol 2005; 16: 5-3.
• Gupta DK, Sankhwar SN, Goel A. Uroflowmetry nomograms for healthy children 5 to 15 years old. J Urol 2013; 190: 1008-13.
• Combs AJ, Grafstein N, Horowitz M, Glassberg KI. Primary bladder neck dysfunction in children and adolescents I: pelvic floor electromyography lag time--a new noninvasive method to screen for and monitor therapeutic response. J Urol 2005; 173: 207-10
• Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S. Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol 2005; 173: 969-73.
• Koff SA. Estimating bladder capacity in children. Urology 1983; 21: 248.
• Samijn B, Van Laecke E, Vande Walle J, et al. Uroflw measurement combined with electromyography testing of the pelvic floor in healthy children. Neurourol Urodid 2019; 38: 231-8.
• Kılıç A, Hacıhamdioğlu DÖ, Tural E, Karademir F. Evaluation of neuropsychological development of children diagnosed with primary monosymptomatic nocturnal enuresis: A pilot study. Turk J Urol 2020; 46: 320-5
• Ferrara P, Franceschini G, Mercurio S, Del Vescovo E, Ianniello F, Petitti T. The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children. Turk J Urol 2018; 44: 51-5.
• Abrams P, Cardoso L, Fall M, et al. The standardization of terminology in lower urinary tract function: report from the standardisation subcommittee of the International Continence Society. Urology 2003; 61: 37-49
• Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol 2011; 27: 437-47.
• Wenske S, Combs AJ, Van Batavia JP, et al. Can staccato and interrupted/fractionated uroflow patterns alone correctly identify the underlying lower urinary tract condition? J Urol 2012; 187: 2188-93.
• Sharifi-Rad L, Seyedian SL, Fatemi-Behbahani SM, Lotfi B, Kajbafzadeh A. Impact of transcutaneous interferential electrical stimulation for management of primary bladder neck dysfunction in children J Pediatr Urol 2020; 16: 36.
• Corcos J, Schick E. Prevelence of overactive bladder and incontinence in Canada. Can J Urol 2004; 11: 2278-84.
• Ergin G, Kibar Y, Ebiloğlu T, et al. The role of urinary nerve growth factor for the diagnosis and assessment of the biofeedback success in children with dysfunctional voiding. J Pediatr Urol 2016; 12: 118.