Streamlining risk stratification in infants and young children with spinal dysraphism: Vesicoureteral reflux and/or bladder trabeculations outperforms other urodynamic findings for predicting adverse outcomes

Timberlake, Matthew D.; Jacobs, Micah A.; Kern, Adam; Adams, Richard N.; Walker, Candice; Schlomer, Bruce J.

doi:10.1016/j.jpurol.2018.05.023

Cited by 23 publications

(8 citation statements)

References 17 publications

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“…23 Bladder trabeculation may indicate early deterioration of NB function. 23 Matthew et al 24 found that bladder trabeculation might be associated with febrile UTI in young children with NB. However, Seki et al 6 reported that bladder trabeculation tended to be associated with febrile UTI, but the association did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Jiang

Deng

Zhou

et al. 2022

Urology

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To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization. MATERIALS AND METHODSOver a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had clean intermittent catheterization. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups. RESULTSOf 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (P <.05), respectively. CONCLUSION These results suggest that older age, high level of spinal cord lesions, long duration of NB, vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs. UROLOGY 00: 1−6, 2022. © 2022 Elsevier Inc.N eurogenic bladder (NB) is defined as a dysfunctional bladder because of a spinal cord lesion at any level. 1 This condition contributes to various pathophysiological mechanisms of NB in children, including urine retention, incontinence, urinary tract infection (UTI), and vesicoureteral reflux (VUR), and ultimately leads to renal scarring and renal failure. 1 Conservative treatment should be performed immediately after the confirmed diagnosis of NB. 2 Clean intermittent catheterization (CIC) or intermittent self-catheterization is commonly recommended for patients with NB having bladder emptying problems. 3 The introduction of CIC has significantly decreased the cases of renal deterioration by reducing the bladder pressure and preventing upper urinary tract damage. 4 However, CIC increases the risk of bacteriuria in patients with NB by introducing urethral microorganisms into the urinary bladder during the repeated catheterizations. 5 Interestingly, some patients with NB managed by CIC have recurrent symptomatic UTIs, but others rarely or never experience them. 5 Hence, few factors may increase the risk of recurrent symptomatic UTIs. Moreover, recurrent UTI, especially pyelonephritis, results in renal scarring and contributes to kidney deterioration. 3 Therefore, identifying the possible risk factors for recurrent symptomatic UTI in children is necessary. Although the ris...

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Jiang

Deng

Zhou

et al. 2022

Urology

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“…To the best of our knowledge, longitudinal studies using multiple DMSA scans from childhood to young adulthood in patients with SB have been quite rare. (11) From a practical perspective, detecting the development of new renal scarring is more critical than evaluating the prevalence of old renal scarring. To investigate new renal scarring, longitudinal studies using DMSA scans are necessary.…”

Section: Discussionmentioning

confidence: 99%

Factors related to renal deterioration in children and young adults with spina bifida: A longitudinal study using dimercaptosuccinic acid scans

Yamazaki

Gohbara

Eura

et al. 2023

Preprint

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Study Design: Retrospective, cohort study Objectives: First, to investigate the prevalence of new DMSA abnormalities by age in patients with spina bifida, and second, to evaluate the age differences in risk factors for new DMSA abnormalities. Setting: Children’s hospital in Yokohama, Japan Methods: All patients with spina bifida requiring clean intermittent catheterization who visited from 2009 to 2021 were enrolled. Inclusion criteria consisted of having at least two DMSA scans performed at age ≤12 years and ≥13 years. Patients with no sequential data from video urodynamic studies were excluded. Risk factors for new DMSA abnormalities were evaluated in two different growth stages (age ≤12 years, age ≥13 years). Results Fifty-seven patients with a median follow-up of 18 years were included. At the end of the study, 22 patients (39%) had DMSA abnormalities. The number of patients having new DMSA abnormalities in childhood (age ≤12 years) and in young adulthood (age ≥13 years) was 10 (18%) and 12 (21%), respectively. After the LASSO logistic analysis, three variables (maximum detrusor pressure, vesicoureteral reflux, and bladder trabeculation) were identified as factors related to new DMSA abnormalities in children. On the other hand, vesicoureteral reflux was the only related factor in young adults. Conclusions: In children with spina bifida, there was no age tendency in the development of new DMSA abnormalities. Vesicoureteral reflux was related to new DMSA abnormalities in both childhood and young adulthood. However, video urodynamics parameters were related to new DMSA abnormalities only in childhood.

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“…Initiation of medical intervention is based on patients achieving continence, or results of imaging and other urologic test parameters. If signs of upper urinary tract changes appear, patients should undergo urodynamic testing to assess the nature of, and need for surgical intervention 63 . Surgical intervention is considered for those at risk for renal deterioration who do not achieve satisfactory continence with medical management 64 .…”

Section: Natural History Of Fetal Spina Bifidamentioning

confidence: 99%

Fetal spina bifida: What we tell the parents

et al. 2020

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Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.

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Streamlining risk stratification in infants and young children with spinal dysraphism: Vesicoureteral reflux and/or bladder trabeculations outperforms other urodynamic findings for predicting adverse outcomes

Cited by 23 publications

References 17 publications

Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Factors related to renal deterioration in children and young adults with spina bifida: A longitudinal study using dimercaptosuccinic acid scans

Fetal spina bifida: What we tell the parents

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