SUN-104 Long term outcome of childhood bladder dysfunction

Abstract

Bladder dysfunction is an important cause of chronic kidney disease (CKD). It could be due to neurogenic causes mostly spinal lesion (SL), Hinman syndrome or non-neurogenic neurogenic bladder (NNNB) and following posterior urethral valve ablation named valve bladder syndrome (VBS). A retrospective study of all children with neurogenic bladder (NB) over 12 years duration from single center. 199 children (134, boy, 67.3%), were included and divided into three groups; group1 (75 NNNB), group2 (64 SL) and group 3 (60 VBS). Their mean (SD) age at presentation was 43.96(49.66) month. The mean (SD) duration of follow up 71.79(45.46) month. Urodynamic study was done in 85 children before any surgical intervention, it revealed impaired bladder capacity in 49 children (57.6%), atonic bladder in one child (1.1%) while normal bladder compliance in 35 children (41.1%). 113 children (56.8%) were performing clean intermittent catheterization (CIC). Surgical interventions were required in 86 (43.2%). A significant improvement in the mean eGFR and the CKD stages was observed among the three studied groups but the NNNB group showed the least improvement. Children diagnosed and started management during their first year of life had better outcome. Performing CIC without the need for surgical intervention were associated with more improvement of renal function. Pyelonephritis and hydronephrosis have significant negative impact on kidney function. Renal scars was positive in 62%, but did not have negative effect on eGFR at the last follow up. Forty children (20%) progressed to end stage kidney disease (ESKD), mainly from the VBS group. Renal replacement therapy was performed in 23 children (11.5%); 11 hemodialysis, 11 peritoneal dialysis and one child received renal transplantation. Mortality was 7.5% (15 children), caused y ESKD complications in 10 children, while the remaining 5 children died from non-renal causes. Diagnosis and management of NB in early infancy is associated with better outcome. Successful CIC is more beneficial than vesicostomy and NB caused by spinal lesion is the best regarding preservation of kidney function, while VBS group is the worst.