Modified VCU technique

A slightly modified VCU technique allows the diagnosis of (uninhibited) unstable detrusor contractions and therefore the diagnosis of unstable bladder with accuracy similar to that of urodynamic techniques (sensitivity 93%, specificity 90.7%) (Potter et al. 1986). 

A slightly modified VCU technique allows the diagnosis of unstable detrusor contractions with similar accuracy to urodynamic techniques. Spinning top urethra and wide bladder neck anomaly, even in the absence of unstable bladder, should alert the attention to occult or healed dysfunction. 

For the evaluation of children with symptoms of nonneurogenic bladder-sphincter dysfunction by ultrasound, a careful examination of the urinary bladder has to be performed in particular. Not only structural abnormalities have to be searched for bladder wall thickness, bladder volume and residual urine volume after voiding have to be assessed. Similar as described before for the modified VCU technique, the bladder base and bladder neck respectively have to be observed carefully by ultrasound as well. A transient opening of the bladder neck together with uninhibitetd detrusor contractions with filling of the posterior urethra up to the con-... 

Altogether, it should be underlined that a slightly modified VCU technique allows the diagnosis of unstable bladder (overactive bladder) to be made in centers without urodynamic facilities with similar accuracy. Therefore, modified VCU is recommended in all children for the evaluation of symptoms of persistent and severe nonneurogenic bladder-sphincter dysfunction, in particular with (febrile) UTI and breakthrough infections and in all neonates and infants for the evaluation of upper urinary tract dilatation and extended ultrasound signs indicative of VUR. 

Functional questions can be answered by urodynamics video-urodynamics provide simultaneous analysis of functional and morphologic findings. A modified VCU technique can also assess both functional disturbance and morphologic alterations. 

---