Tract Deterioration In Children Research Articles

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury.

The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamicfindings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.

The role of occult spinal malformation and upper urinary tract deterioration in children with intractable voiding dysfunction

Objectives: To evaluate the presence of upper urinary tract deterioration (UUTD) and accompanying pathologies in children treated with the diagnosis of non-neurogenic bladder-sphincter dysfunction (NNBSD). Patients and Methods: We retrospectively reviewed the medical records of 316 consecutive patients with NNBSD who were treated. All cohort were grouped into two: Group I (Treatment success; n=284), Group II (Treatment failure with any form of occult spinal pathology; n=32). Thirty-four children with treatment-failure and normal magnetic resonance imaging (MRI) findings were excluded. Groups were compared for pre- and posttreatment pediatric lower urinary tract symptom score (PLUTSS), presence of UUTD and urodynamic findings. Results: The mean PLUTSS was significantly less in Group I compared with Group II at pre-treatment and 3 months thereafter the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14 and 18 ± 3.4, respectively p 20 cm H2O and presence of vesicoureteral reflux (VUR). Conclusion: UUTD in NNBSD is more common in children with occult spinal pathology, than in those without. Keywords: Non-neuropathic bladder sphincter dysfunction, Upper urinary tract deterioration, Symptom score

Risk Factors for Upper Urinary Tract Deterioration in Children with Neurogenic Bladder

Purpose: We evaluated the risk factors for upper urinary tract deterioration in children with neurogenic bladder. Materials and Methods: The study population consisted of 60 children (36 boys, 24 girls) with neurogenic bladder confirmed by urodynamic study between January 1994 and June 2007. The average follow-up period was 48 months. The patients' medical records were assessed concerning gender, presence of vesicoureteral reflux (VUR), hydronephrosis, type of spinal dysraphism, level of spinal dysraphism, practice of clean intermittent catheterization (CIC), type of neurogenic bladder, bladder capacity, compliance, detrusor sphincter dyssynergia, recurrent urinary tract infection (UTI), and timing of primary neurosurgical repair. Upper urinary tract deterioration was diagnosed by 99m technetium-dimercaptosuccinic acid renal scan (DMSA) and aggravation of hydronephrosis and VUR. Results: Upper urinary tract deterioration was detected in 15 patients (25%). Hydronephrosis, VUR, and UTI were associated with upper urinary tract deterioration in the univariate analyses. In the multivariate analyses, hydronephrosis [odds ratio (OR)=2.181, 95% confidence interval (CI)=1.191-11.941, p=0.036] and recurrent UTI [OR=5.810, 95% CI=1.200-28.192, p=0.029] were independent risk factors for upper urinary tract deterioration. Conclusions: Hydronephrosis and recurrent UTI increase the risk of upper urinary tract deterioration in children and adolescents with neurogenic bladder. Therefore, intensive observation and prompt intervention may be recommended for such cases.

Ultrasonographic Measurement of Bladder Wall Thickness as a Risk Factor for Upper Urinary Tract Deterioration in Children With Myelodysplasia

We investigated the correlations between ultrasonographic bladder wall thickness and urodynamic parameters, and estimated the diagnostic accuracy of bladder wall thickness for predicting unfavorable urodynamic patterns in children with myelodysplasia. A total of 57 children (median age 5.1 years) with myelodysplasia were enrolled in the study. All children underwent ultrasonography to measure bladder wall thickness. Videourodynamic evaluation was also performed within 3 months of ultrasound assessment. Bladder wall thickness was compared to urodynamic data. A urodynamic risk of upper urinary tract deterioration was defined as maximum detrusor pressure greater than 40 cm H(2)O during filling or at leakage, or sphincter dyssynergia during voiding. Bladder wall thickness was significantly correlated to detrusor leak point pressure, maximum amplitude of detrusor overactivity and maximum detrusor pressure during storage phase. In 16 children who had unfavorable urodynamic risk patterns the mean bladder wall thickness was 3.9 +/- 1.0 mm, compared to 2.4 +/- 0.7 mm in 41 patients with favorable urodynamic patterns. There was a significant difference between bladder wall thickness in children with and those without urodynamic risk factors (p <0.001). For a diagnosis of unfavorable urodynamic patterns bladder wall thickness greater than 3.3 mm had a positive predictive value of 85.7%, a negative predictive value of 90.7%, specificity of 75.0% and sensitivity of 95.1%. Receiver operator characteristic analysis revealed that bladder wall thickness had a high predictive value for unfavorable urodynamic patterns, with an area under the curve of 0.908. Ultrasonographic assessment of bladder wall thickness is a sensitive screening tool for the diagnosis of urodynamic risk factors for upper urinary tract deterioration in children with myelodysplasia.

1370: Ultrasonographic Measurement of Bladder Wall Thickness as a Risk Factor for Upper Urinary Tract Deterioration in Children with Myelodysplasia

You have accessJournal of UrologyModerated Poster, Tuesday, May 23, 2006, 1:00 - 3:00 pm1 Apr 20061370: Ultrasonographic Measurement of Bladder Wall Thickness as a Risk Factor for Upper Urinary Tract Deterioration in Children with Myelodysplasia Hiroshi Tanaka, Mayuko Matsuda, Kimihiko Moriya, Takahiko Mitsui, Tuyoshi Furuno, Takeya Kitta, and Katsuya Nonomura Hiroshi TanakaHiroshi Tanaka More articles by this author , Mayuko MatsudaMayuko Matsuda More articles by this author , Kimihiko MoriyaKimihiko Moriya More articles by this author , Takahiko MitsuiTakahiko Mitsui More articles by this author , Tuyoshi FurunoTuyoshi Furuno More articles by this author , Takeya KittaTakeya Kitta More articles by this author , and Katsuya NonomuraKatsuya Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33583-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1370: Ultrasonographic Measurement of Bladder Wall Thickness as a Risk Factor for Upper Urinary Tract Deterioration in Children with Myelodysplasia." The Journal of Urology, 175(4S), p. 441 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 441 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Hiroshi Tanaka More articles by this author Mayuko Matsuda More articles by this author Kimihiko Moriya More articles by this author Takahiko Mitsui More articles by this author Tuyoshi Furuno More articles by this author Takeya Kitta More articles by this author Katsuya Nonomura More articles by this author Expand All Advertisement PDF DownloadLoading ...

Nocturnal Bladder Emptying: A Simple Technique for Reversing Urinary Tract Deterioration in Children With Neurogenic Bladder

Nocturnal Bladder Emptying: A Simple Technique for Reversing Urinary Tract Deterioration in Children With Neurogenic Bladder

NOCTURNAL BLADDER EMPTYING:: A SIMPLE TECHNIQUE FOR REVERSING URINARY TRACT DETERIORATION IN CHILDREN WITH NEUROGENIC BLADDER

In this preliminary study we sought to determine the effect of instituting nocturnal bladder emptying (NBE) in children with neurogenic (NGB) or nonneurogenic neurogenic bladder (NNGNGB) in whom urinary tract deterioration developed despite optimal daytime clean intermittent catheterization (CIC) and urotropic medications. We hypothesize that a syndrome of nocturnal overdistention of the bladder (SNOB) can cause urinary tract deterioration through increased nighttime storage pressures manifested by recurrent urinary tract infection (UTI), worsening incontinence, hydronephrosis and/or decreasing bladder compliance and capacity, and may be reversed by NBE. A total of 19 children with NGB (17) or NNGNGB (2) who displayed urinary tract deterioration while on CIC and urotropic medications were started on NBE. Of the patients 15 used a continuously draining nighttime catheter while 4 had scheduled awakenings during the night to perform CIC. The primary indications for NBE were recurrent symptomatic UTI in 5, new or progressive hydronephrosis in 7, and decreasing bladder capacity and compliance in 7. At a mean followup of 23 months 15 (79%) patients showed improvement or complete resolution of 1 or more signs or symptoms of hydronephrosis (7), increase in bladder capacity (5), recurrent UTI (6) and worsening incontinence (3). The remaining 4 patients had no response to NBE. No adverse effects were observed with 10 hours or less of nightly indwelling catheter time. Patients with NGB or NNGNGB on idealized daytime programs of CIC and urotropic drugs may have high intravesical pressures and experience urological deterioration because of an unrecognized SNOB. NBE is a simple technique for treating this condition and reversing the pathophysiological changes. The observation that NBE alone may increase bladder compliance and capacity sufficient to avoid bladder augmentation suggests that development of decreased bladder compliance and capacity in children with NGB may not simply represent normal progression of NGB disease. These changes may be avoidable consequences of untreated SNOB. Early institution of NBE may prevent urinary tract deterioration from developing in this population.

UROLOGICAL OUTCOME OF PATIENTS WITH CERVICAL AND UPPER THORACIC MYELOMENINGOCELE

Purpose: We determined the incidence of voiding disorders and upper tract deterioration in children with cervical and upper thoracic level myelomeningocele.Materials and Methods: We retrospectively reviewed the neurosurgical and urological presentation, evaluation and treatment of 11 patients of whom 8 had cervical and 3 had upper thoracic myelomeningocele. There were 7 female and 4 male patients 10 months to 39 years old (mean age 12 years). All patients were ambulatory and 5 of 11 (45%) had hydrocephalus. Although a voiding history was obtained by a neurosurgeon in all patients, only 9 had undergone a formal urological evaluation, including video urodynamic assessment in 5.Results: No patient had an increased post-void residual and none had ever been placed on intermittent catheterization. Tethered spinal cords from caudal fixation (thickened filum terminale and a lipomyelomeningocele) were present in 2 patients with urinary incontinence of whom 1 had recurrent cystitis. Imaging studies of the upper tra...

Urological outcome of patients with cervical and upper thoracic myelomeningocele.

We determined the incidence of voiding disorders and upper tract deterioration in children with cervical and upper thoracic level myelomeningocele. We retrospectively reviewed the neurosurgical and urological presentation, evaluation and treatment of 11 patients of whom 8 had cervical and 3 had upper thoracic myelomeningocele. There were 7 female and 4 male patients 10 months to 39 years old (mean age 12 years). All patients were ambulatory and 5 of 11 (45%) had hydrocephalus. Although a voiding history was obtained by a neurosurgeon in all patients, only 9 had undergone a formal urological evaluation, including video urodynamic assessment in 5. No patient had an increased post-void residual and none had ever been placed on intermittent catheterization. Tethered spinal cords from caudal fixation (thickened filum terminale and a lipomyelomeningocele) were present in 2 patients with urinary incontinence of whom 1 had recurrent cystitis. Imaging studies of the upper tracts were normal in all 9 patients and video urodynamics were normal in 3 of 5. No patient has required urological operative intervention. To our knowledge, this study represents the largest reported series of patients with cervical and upper thoracic myelomeningocele who have undergone urological evaluation. Our experience suggests that patients with cervical and upper thoracic myelomeningocele have a low risk of voiding disorders and upper tract deterioration unless other conditions, such as a congenital tethered cord, are present. Additional reports of children with cervical and upper thoracic myelomeningocele are necessary to confirm these findings.

Urodynamic predictors of upper tract deterioration in children with myelodysplasia.

The clinical and urodynamic data of 62 children with myelodysplasia without previous urological treatment were tested statistically for the ability to predict upper tract deterioration. This was done by comparing these data among 26 children with dilated upper tracts and 36 children with normal upper tracts. Vesicoureteric reflux had a strong positive correlation with upper tract dilation but the maximum cystometric capacity, detrusor instability, compliance, maximum urethral closure pressure and peak flow rate all had no predictive value. Residual urine is sensitive and negatively predictive and leak pressure is specific and positively predictive; detrusor pressure at peak flow, opening pressure, pressure at least flow and the detrusor-adjusted mean passive urethral resistance relation factor (DAMPF) are sensitive and specific with high positive and negative predictive values.

Decreased Bladder Compliance in Patients With Myelomeningocele Treated With Radiological Observation

Purpose Recently others advocated frequent radiological surveillance to detect upper urinary tract deterioration in children with neurogenic bladder secondary to spina bifida. We reviewed the consequences of such expectant management on bladder compliance and urinary continence. Materials and Methods We retrospectively reviewed the records of 214 children presenting to our spina bifida clinic in a 13-year period. Followup is available for 95 girls and 86 boys. Imaging studies of the kidneys were repeated at 6 to 12-month intervals. Urodynamics were performed when upper urinary tracts deteriorated or in incontinent school age children. Results On radiographic study there was evidence of upper urinary tract deterioration in 79 children, including hydronephrosis in 34, hydronephrosis and vesicoureteral reflux in 19, and reflux only in 26. Followup studies performed after clean intermittent catheterization and pharmacological therapy were instituted revealed resolution or improvement of upper tract deterioration in 52 patients (69 percent), while bladder compliance improved in only 42 percent. Surgical intervention was required in 34 children, despite improvement of upper tract changes in many of these patients on followup radiographic studies. Conclusions Although radiological surveillance of patients with myelomeningocele allows recognition of upper tract changes, the effects of elevated outlet resistance on bladder compliance are not as readily reversible as the initial radiographic findings. The incidence of enterocystoplasty exceeds that reported for patients treated prospectively based on urodynamic findings, which should be considered in the treatment of these children.

An Alternative Approach to Myelodysplasia Management: Aggressive Observation and Prompt Intervention

We have adopted an approach to the management of myelodysplasia patients which is contrary to that most commonly supported by the existing literature. We screen patients shortly after birth with ultrasound, urine culture and serum creatinine, and then follow patients at 3 to 6-month intervals with similar studies. Cystography and urodynamics are done only as required clinically or by a change in the sonogram. Clean intermittent catheterization is indicated for continence or medical reasons. With this approach of aggressive observation and prompt intervention, we observed a rate of renal deterioration (diminished function on renal scan or parenchymal loss on imaging studies) of 5%. Renal deterioration was associated statistically with urinary tract infections and reflux. Patients started on clean intermittent catheterization for medical indications had greater risk for renal deterioration than those started on it for continence. Renal deterioration occurred with equal frequency between patients with abnormal and normal urodynamic studies, that is urodynamics did not predict renal deterioration. Our data show a rate of renal deterioration similar to other reports. We believe that aggressive observation with prompt intervention for problems once identified represents a reasonable alternative to managing patients with myelodysplasia.