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The value of urodynamic studies in infants less than 1 year old with congenital spinal dysraphism
L M Perez1, J Khoury, G D Webster
1Division of Urology, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Urodynamic studies in infants with congenital spinal dysraphism are crucial. Higher "hostility scores" during early studies correlate with upper tract deterioration, indicating the need for timely urological evaluation.
Area of Science:
- Pediatric Urology
- Neurology
- Nephrology
Background:
- Congenital spinal dysraphism presents complex urological challenges in infants.
- The optimal timing and interpretation of urodynamic studies in this population remain debated.
- Early identification of lower urinary tract dysfunction is critical for preventing upper tract damage.
Purpose of the Study:
- To evaluate the utility of video urodynamic studies in infants with congenital spinal dysraphism.
- To assess the correlation between urodynamic study "hostility" and upper urinary tract outcomes.
- To determine the role of repeat urodynamic studies in managing these patients.
Main Methods:
- A retrospective review of 64 infants with congenital spinal dysraphism undergoing video urodynamic study before age 1.
- Application of a "hostility score" (0-10) to each study.
- Comparison of hostility scores with upper tract changes and subsequent urodynamic findings.
Main Results:
- Infants with high hostility scores (≥5) showed significantly higher rates of upper tract deterioration (39%) compared to those with low scores (9%).
- Repeat urodynamic studies after age 1 revealed high hostility in 6 of 14 patients initially in the low hostility group.
- Urodynamic findings correlated with the risk of upper tract damage.
Conclusions:
- Video urodynamic studies are valuable tools for assessing infants with spinal dysraphism.
- The "hostility score" can predict the risk of upper tract deterioration.
- Urodynamic evaluation during and after the first year of life is essential for appropriate urological management.
Abstract:
The role and timing of urodynamic studies in infants with congenital spinal dysraphism are controversial. We reviewed 64 consecutive infants with a mean followup of 28 months who underwent video urodynamic study when they were less than 1 year old (50 of the 64 patients were less than 3 months old). A previously reported video urodynamic "hostility score" from 0 (best) to 10 (worst) was given to each study and compared with the outcome of the upper urinary tract and subsequent urodynamic studies. A larger fraction of these children with high hostility scores (5 or greater) had upper tract deterioration (39%) compared to those with low hostility scores (9%). Moreover, 6 of 14 patients in the low hostility group who underwent repeat video urodynamic studies after age 1 year had high hostility lower urinary tracts. We conclude that urodynamic studies during and after the first year of life are useful in the appropriate urological evaluation and management of infants with spinal dysraphism.