Ability of a normal dysfunctional voiding symptom score to predict uroflowmetry and external urinary sphincter electromyography patterns in children

Purpose: We correlated uroflowmetry/electromyography (EMG) patterns and post-void residual urine volume (PVR) in children with a normal dysfunctional voiding symptom score (DVSS) and determined whether a normal DVSS can predict uroflowmetry/EMG/PVR results. Materials and Methods: We prospectively studied 51 children with a normal DVSS, and negative neurological and urological history who underwent uroflowmetry/EMG and PVR measurements. Statistical results were correlated with patient age and gender using Cohen's kappa and Fisher's exact test. Results: All children had a normal DVSS for gender and 37 (73%) had bell-shaped uroflowmetry curves. Eight of the 14 children with nonbell-shaped uroflowmetry curves had plateaued and 6 had fractionated curves. Five boys and 13 girls (35%) had decreased EMG patterns, 7 boys and 8 girls (29%) had increased patterns and 5 boys and 13 girls (35%) had variable patterns (Cohen's kappa score 0.11). Of the 37 children (65%) with bell-shaped uroflowmetry curves 24 had normal PVR, while 13 of 37 (35%) had elevated PVR. Eight of the 14 children (57%) with nonbell-shaped uroflowmetry curves had normal PVR and 6 (43%) had elevated PVR (Cohen's kappa score 0.13). Seven of 37 children (19%) with bell-shaped uroflowmetry curves and 7 of 14 (50%) with nonbell-shaped uroflowmetry curves had a significantly distended bladder (p = 0.04). Nine of the 14 children (64%) with a significantly distended bladder had abnormal PVR. Ten of the 37 children (27%) without a significantly distended bladder had abnormal PVR (p = 0.02). Conclusions: Normal DVSS for gender is able to predict a bell-shaped uroflowmetry curve in most children, while EMG patterns and PVR do not correlate with uroflowmetry curves in these children. Children with a significantly distended bladder frequently have nonbell-shaped uroflowmetry curves as well as elevated PVR.