Introduction: The calculation of continuous measurement of the area under the curve generated by the detrusor pressure tracing is a new promising parameter that may reflect the impairment of the upper urinary tract and renal function. The aim of this study is to analyse the clinical utility of this parameter in paediatric patients with neuropathic lower urinary tract dysfunction (NLUTD).

Methods: Retrospective study of urodynamic studies from paediatric patients (<15 years old) between 2011-2023. Patients were grouped as functional or neuropathic depending on the underlying condition.

Dependent variables: upper urinary tract dilation (UTD), secondary vesico-ureteral reflux (VUR), recurring urinary tract infection (UTI) or acute pyelonephritis. Area under the curve of the detrusor pressure tracing was calculated using closed Newton-Cotes methods and then divided based on the achieved bladder capacity obtaining the following indices: Simpson index [SI], trapezoidal index [TI]. Diagnostic performances were assessed using ROC curves.

Results: 210 patients were included. 76.2%(n=160) had neuropathic bladder. The median age in neurogenic group was 9 (4-12.5) years (p=0.029). 41 (25,6%) patients in neurogenic group reported Grade 2-3 UTD (p=0,012), 30 (18,8%) presented with II-IV grade VUR and 51 (32%) suffered from recurring UTI (p = 0.04). There were no differences in DLPP among two groups (p = 0,765). Our proposed indices were higher in neurogenic group (p < 0.05). In the univariate analysis in patients with recurring UTI, UTD Grade 2-3 and VUR, both indices were higher (p<0.05). The ROC analysis of both indices performed better than the actual.

Discussion: In paediatric patients with neuropathic lower urinary tract dysfunction, measuring the area under the curve of the detrusor pressure tracing demonstrated clinical utility. Good diagnostic performance concerning upper urinary tract dilation, vesico-ureteral reflux and urinary tract infection was achieved. Both indices performed better than classic parameters such as detrusor leak point pressure.

Conclusions: In paediatric patients with lower urinary tract dysfunction, measuring the area under the curve of the detrusor pressure trace demonstrated clinical utility. Both Simpson and Trapezoidal index performed better than classic parameters such as DLPP in relation to vesicoureteral reflux, upper urinary tract dilation, and recurring urinary tract infection in neurogenic patients.

Keywords: Diagnosis; Paediatric; Research; Urodynamics.

Copyright © 2025. Published by Elsevier Inc.

介绍： 计算逼尿肌压力曲线下的连续测量面积是一个新的有前景的参数，可能反映了上泌尿系统和肾功能的损害。本研究旨在分析该参数在神经源性下泌尿道功能障碍（NLUTD）患儿中的临床实用性。

方法： 回顾性分析2011年至2023年间儿科患者的尿动力学检查数据（年龄小于15岁）。根据基础疾病将患者分为功能性或神经源性两组。

依赖变量： 上泌尿系统扩张（UTD）、继发性膀胱-输尿管反流（VUR）、反复发生的泌尿道感染（UTI）或急性肾盂肾炎。使用封闭的牛顿-科茨方法计算逼尿肌压力曲线下的面积，并根据实现的膀胱容量进行划分，得到以下指标：辛普森指数 [SI]、梯形指数 [TI]。通过ROC曲线评估诊断性能。

结果： 共纳入210名患者。76.2%（n=160）的患者为神经源性膀胱。神经源组的中位年龄为9 (4-12.5) 岁（p=0.029）。在神经源组中有41名（25.6%）患者报告了UTD 2-3级（p=0.012），有30名（18.8%）患有VUR II-IV 级，以及51 名（32%）患有反复泌尿道感染（p = 0.04）。两组之间DLPP无差异（p = 0.765）。我们提出的指数在神经源性组中更高（p

讨论： 在患有神经源性下泌尿道功能障碍的儿科患者中，测量逼尿肌压力曲线下的面积显示了临床实用性。对于上泌尿系统扩张、膀胱-输尿管反流和泌尿道感染的良好诊断性能得以实现。两种指数的表现优于经典参数如DLPP。

结论： 在下泌尿道功能障碍的儿科患者中，测量逼尿肌压力轨迹下的面积显示了临床实用性。辛普森指数和梯形指数在神经源性患者的膀胱-输尿管反流、上泌尿系统扩张以及反复发生的泌尿道感染方面优于传统参数如DLPP。

关键词： 诊断；儿科；研究；尿动力学。