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CHOC Urodynamics Program Receives Medtronic Upgrade

The CHOC Urodynamics Program has been upgraded with a Medtronic Duet Logic system. The portable,Windows-based system provides advanced urodynamic testing to clarify diagnoses of neurogenic bladder, including the following standard tests: uroflowmeter, pressure flow studies, cystometry, bladder leak point measurement, sphincter EMG.

The Medtronic system may also be used with X-ray equipment to produce video images. The program is supported full-time by pediatric nurse Alison Ashby, R.N., B.S.N. "The advantages of the Medtronic system are smaller probes and more precise, detailed information about bladder function, which is especially important for our spina bifida patients," says CHOC pediatric urologist Joseph Raffel, M.D.

Neurogenic bladder disorders may develop as a result of a lesion at any level in the nervous system, including the cerebral cortex, the spinal cord or the peripheral nerves.

In addition to working closely with the CHOC Spina Bifida Clinic, the CHOC Urodynamics Program provides studies for children recovering from spinal cord injuries or who have tumors.

"Sometimes we see changes in the nerves to the bladder sphincter area before there are changes to the lower extremities," Dr. Raffel says. "Determining whether a child has an atonic bladder, spastic bladder or a more normal bladder may help neurosurgeons determine whether there is a tethered cord that might need to be released. We can also track changes from previous urodynamic studies."

Urologist David Chamberlin, M.D., also works with the CHOC Urodynamics Program, particularly with spina bifida patients. With these patients, his concern is kidney function, and he uses the Medtronic unit to measure volumes and pressures, particularly leak point pressure.

"As long as the bladder leaks at a low pressure, we know the patient will probably do okay with kidney function for awhile. But if the patient leaks at a high pressure, there will likely be a problem with the kidneys. We can initiate medical management or surgical management, as necessary, to avoid this," Dr. Chamberlin says.

Incontinence becomes an issue for school-age children, particularly those transitioning into adolescence or adulthood. Depending on the circumstances, medical management or reconstructive surgery, such as bladder augmentation, catheterizable continent stomas or ACE stomas for bowel care may be recommended.

STUDIES FOR DYSFUNCTIONAL VOIDERS

Urodynamic studies are also performed on patients with complex urinary incontinence issues. The results can rule out possible neurological causes and determine whether a child could benefit from medication, behavior modification or biofeedback training.

Pediatric urologist Barry Duel, M.D., who is also on staff at CHOC, recommends a voiding cystourethrogram (VCUG) and ultrasound particularly if the patient has a history of recurrent urinary tract infections.

"Unless a child with incontinence has had recurrent urinary tract infections, I usually start with a program of medication and behavior modification. If those simple measures do not work, then I recommend a urodynamic study," he says.

Joseph Raffel, M.D., and Barry Duel, M.D., are the only pediatric urologists in the region working exclusively with children. Urologist David Chamberlin, M.D., also treats pediatric patients at CHOC.

For more information about the CHOC Urodynamics Program, please contact Dr. Raffel at 714-639-3134.

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Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

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