Is 40 cm H2O detrusor leak point pressure (DLPP) cut-off really reliable for upper urinary tract (UUT) protection in children with myelodysplasia?

Abstract

INTRODUCTION AND OBJECTIVE: High DLPP is a risk factor for UUT in children with myelodysplasia, where 40 cm H2O is generally considered as the safe limit after McGuire’s study. The purpose of this study is to find out the most accurate cut-off level for the DLPP in terms of UUT protection in children with myelodysplasia. METHODS: We retrospectively reviewed 618 children with myelodysplasia followed at our multidisciplinary clinic between 1996 and 2008. Among these patients, 150 were included in the study based on the availability of urological follow-up data at age of 3 years. Children were assigned to 1 of 2 groups those who had UUT deterioration at age 3 (group 1), which means hydronephrosis, VUR or scar on DMSA, or not (group 2). We compared the incidence of febrile urinary tract infections (FUTI), timing of the primary neurosurgical repair, secondary tethering of the spinal cord (STSC) at age 3 years and urodynamic findings between the groups. RESULTS: Conservative treatment rates are shown in table 1 and urodynamic findings in table 2. Urological follow-up data at age 3 years revealed higher incidences of FUTI and STSC in children in group 1. Different cut-off values of DLPP showed that DLPP above 20 cm H2O has a higher sensitivity for UUT deterioration (table 3). CONCLUSIONS: Determining the cut-off value of the DLPP as 20 cm H2O instead of 40 cm H2O showed a higher sensitivity to predict the risk group for UUT deterioration. Children with myelodysplasia, who have a DLPP between 20 and 40 cm H2O, should be followed closer since % 38.4 of these children in this study had UUT deterioration at age of 3.