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Lower urinary tract function after exstrophy closure
J G Hollowell1, P D Hill, P G Duffy
1Department of Urology, Hospital for Sick Children, London, UK.
Insights
Children with bladder exstrophy have key urinary tract function parameters that predict upper tract damage and limited bladder capacity. Higher leak pressure (LP) and fewer involuntary contractions correlate with better bladder capacity and reduced risk.
Area of Science:
- Pediatric Urology
- Urology
- Nephrology
Background:
- Bladder exstrophy presents significant challenges for lower urinary tract function.
- Identifying risk factors for upper tract damage and impaired bladder capacity is crucial for surgical planning.
Purpose of the Study:
- To define lower urinary tract functional parameters that pose a risk for upper tract damage in children with bladder exstrophy.
- To identify factors that impair the development of bladder capacity prior to surgical continence procedures.
Main Methods:
- Urodynamic evaluation, cystogram, ultrasound, and dimercaptosuccinic acid scan were performed on 28 children.
- Analysis focused on leak pressure (LP), involuntary contractions, and end-fill pressure.
Main Results:
- Seven of 28 bladders showed no storage function (LP=0).
- Higher LP and absence of involuntary contractions were associated with better bladder capacity.
- A leak pressure (LP) > 30 cm H2O was linked to upper tract damage (hydronephrosis, scarring).
- Elevated end-fill pressure (>10 cm H2O) was also associated with upper tract damage.
Conclusions:
- Involuntary bladder contractions may hinder bladder capacity development.
- Leak pressure (LP) > 30 cm H2O is a significant risk factor for upper tract damage.
- End-fill pressure > 10 cm H2O may also indicate risk for upper tract damage in bladder exstrophy patients.
Abstract:
Twenty-eight children with bladder exstrophy, prior to surgery for continence, underwent a urodynamic evaluation, cystogram, ultrasound and dimercaptosuccinic acid scan, to define parameters of lower urinary tract function that are a risk for upper tract damage and/or impair development of bladder capacity. The bladders in 7 of 28 demonstrated no storage function [leak pressure)LP) = 0]; but storage parameters could be measured in the other 21. Their LP was 10-35 cm H2O; 17 of 21 revealed involuntary contractions and 7 of 21 had an end-fill pressure greater than 10 cm H2O. Bladder capacity was better in those with a higher LP and those with no involuntary contractions. The 4 patients with bilateral hydronephrosis (3 of whom also had bilateral multiple scars) were among the 6 with LP greater than 30 cm H2O. Of the 7 with an end-fill pressure greater than 10 cm H2O, 5 had upper tract damage. Involuntary contractions may impair development of capacity. A LP of greater than 30 cm H2O is a risk factor for upper tract damage and an end-fill pressure greater than 10 cm H2O may also be a factor.