Bladder Volume Assessment in Pediatric Patients With Neurogenic Bladder: Is Ultrasound an Accurate Method?

Published:October 10, 2020DOI:



      To define the accuracy of ultrasound to determine bladder volume in pediatric patients with neurogenic bladder (NB).


      Retrospective analysis of children with NB in treatment with urethral clean intermittent catheterization. Exclusion criteria: bladder surgeries, and catheterization through a channel different than urethra. Bladder volume was measured with ultrasound using the formula: anteroposterior bladder diameter by side to side diameter by distance from dome to outlet tract by 0.523 (cm3). In the same act, the patient was performed urethral catheterization and the drained volume was measured in millimeters. Finally, postvoid residual volume (PVR) was assessed with ultrasound.


      We performed 318 measurements in 299 patients, mean age was 9.95 years (standard deviation: 4.6), 59% were female. Most frequent etiologies of NB were myelomeningocele and lipomyelomeningocele. Mean ultrasound-determined bladder volume was 213.9cm3 (range: 20-899 cm3) and mean bladder volume drain through catheterization was 336.4 mL (range: 30-1480 mL; P : .0001). In 67.3% of the patients (n: 214) PVR was not significant, and their mean ultrasound volume was 212.7 mL and the volume evacuated by catheterization was 339.9 mL (P : .0001). In all age groups ultrasound-determined bladder volume was statistically lower than catheterized bladder volume (P : .0001). The mean percentage error of the ultrasound-determined bladder volume was 15.58% ± 44.09. Linear regression analysis and Bland-Altman plot showed low agreement between both measurement techniques.


      In children with NB, ultrasound-determined bladder volume was statistically lower than catheterized bladder volume measured at the same moment, and this relation persisted regardless of sex, age, and the presence of PVR.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stein R
        • Bogaert G
        • Dogan HS
        • et al.
        EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management.
        Neurourol Urodyn. 2019; : 1-9
        • Stark GD
        Referral and Assessment. Spina Bifida, Problems and Management.
        Blackwell Scientific Publications, Oxford, UK1977: 75-76
        • Cardona-Grau D
        • Chiang G.
        Evaluation and lifetime management of the urinary tract in patients with myelomeningocele.
        Urol Clin. 2017; 44: 391-401
        • Fernandes ET
        • Reinberg Y
        • Vernier R
        • et al.
        Neurogenic bladder dysfunction in children: review of pathophysiology and current management.
        J Pediatr. 1994; 124: 1-7
        • Torre M
        • Buffa P
        • Jasonni V
        • Cama A
        Long-term urologic outcome in patients with caudal regression syndrome, compared with meningomyelocele and spinal cord lipoma.
        J Pediatr Surg. 2008; 43: 530-533
        • Stein R
        • Bogaert G
        • Dogan HS
        • et al.
        EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment.
        Neurourol Urodyn. 2019; : 1-13
        • Dik P
        • Klijn AJ
        • van Gool JD
        • de Vos CC
        • de Jong TP
        Early start to therapy preserves kidney function in spina bifida patients.
        Eur Urol. 2006; 49: 908-913
        • Hopps CV
        • Kropp KA.
        Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close follow-up.
        J Urol. 2003; 169: 305-308
        • Hwang JY
        • Byun SS
        • Oh SJ
        • Kim HC
        Novel algorithm for improving accuracy of ultrasound measurement of residual urine volume according to bladder shape.
        Urology. 2004; 64: 887‐891
        • Hvarness H
        • Skjoldbye B
        • Jakobsen H
        Urinary bladder volume measurements: comparison of three ultrasound calculation methods.
        Scand J Urol Nephrol. 2002; 36: 177-181
        • Lapides J
        • Diokno AC
        • Silber SJ
        • Lowe BS
        Clean intermittent self-catheterization in the treatment of urinary tract disease.
        J Urol. 1972; 107: 458-461
        • Mitrofanoff P.
        Trans-appendicular continent cystostomy in the management of the neurogenic bladder.
        Chir Pediatr. 1980; 21: 297-305
        • Monti PR
        • Carvalho Lara R
        • Dutra MA
        • Carvalho JR
        New techniques for construction of efferent conduits based on the Mitrofanoff principle.
        Urology. 1997; 49: 112-115
        • Macedo A
        • Srougi M
        A continent catheterizable ileum-based reservoir.
        BJU Int. 2000; 85: 160-162
        • Kroll P
        • Sobieska M
        • Jażdżewska A
        • Żurawski J
        • Gajewska E
        Is there a correlation between structural changes of the bladder wall and its dysfunction? A prospective study.
        Postepy Hig Med Dosw. 2019; 73: 476-482
        • Bis KG
        • Slovis TL.
        Accuracy of ultrasonic bladder volume measurement in children.
        Pediatr Radiol. 1990; 20: 457-460
        • Bih LI
        • Ho CC
        • Tsai SJ
        • Lai YC
        • Chow W
        Bladder shape impact on the accuracy of ultrasonic estimation of bladder volume.
        Arch Phys Med Rehabil. 1998; 79: 1553-1556
        • Poston GJ
        • Joseph AEA
        • Riddle PT
        The accuracy of ultrasound in the measurement of changes in bladder volume.
        Br J Urol. 1983; 55: 361-363
        • Griffiths J
        • Murray A
        • Ramsden D
        Accuracy and repeatability of bladder volume measurement using ultrasonic imaging.
        J Urol. 1986; 136: 808-812
        • Hakenberg OW
        • Ryall RL
        • Langlois SL
        • Marshall VR
        The estimation of bladder volume by sonocystography.
        J Urol. 1983; 130: 249-251
        • Kuzmic A C
        • Brkljacic B
        • Ivankovic D
        The impact of bladder shape on the ultrasonographic measurement of bladder volume in children.
        Pediatr Radiol. 2003; 33: 530-534
        • Selby B
        • Hidas G
        • Chuang K
        • et al.
        Development and validation of a bladder trabeculation grading system in pediatric neurogenic bladder.
        J Pediatr Urol. 2020;
        • Kroll P.
        • Zachwieja J.
        Complications of untreated and ineffectively treated neurogenic bladder dysfunctions in children: our own practical classification.
        Eur Rev Med Pharmacol Sci. 2016; 20: 1229-1237
        • Eid AA
        • Badawy H
        • Elmissiry M
        • Foad A
        • Ebada M
        • Koraitim A
        Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract dysfunction and its effect on bladder dynamics.
        J Pediatr Surg. 2019; 54: 805-808
        • Burgers R
        • Liem O
        • Canon S
        • et al.
        Effect of rectal distention on lower urinary tract function in children.
        J Urol. 2010; 184: 1680-1685
        • Hiraoka M
        • Hori C
        • Tsuchida S
        • Sudo M
        Ultrasonographic evaluation of bladder volume in young children.
        Pediatr Nephrol. 1995; 9: 351-353
        • Hiraoka M
        • Tsukahara H
        • Tsuchida S
        • Hori C
        • Sudo M
        Ultrasonographic evaluation of bladder volume in children.
        Pediatr Nephrol. 1993; 7: 533-535
        • Filgueiras MFTF
        • Lima EM
        • Sanchez TM
        • Goulart EMA
        • Menezes AC
        • Pires CR
        Bladder dysfunction: diagnosis with dynamic US.
        Radiology. 2003; 227: 340-344