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[Cystometric examination for neurogenic bladder of neonates and infants]
1Department of Pediatric Urology, Kobe Children's Hospital.
Insights
Cystometry in infants with spina bifida effectively evaluates bladder function and predicts upper urinary tract damage. Early detection allows for timely treatment, such as clean, intermittent catheterization, to prevent deterioration.
Area of Science:
- Pediatric Urology
- Neuroscience
- Medical Imaging
Background:
- Spina bifida frequently leads to neurogenic bladder dysfunction in neonates and infants.
- Early identification of bladder abnormalities is crucial for preventing upper urinary tract damage.
Purpose of the Study:
- To evaluate the utility of cystometry and cystography in neonates and infants with spina bifida.
- To assess bladder function and predict potential upper tract deterioration.
- To guide treatment selection for neurogenic bladder in pediatric patients.
Main Methods:
- Cystometry and cystography were performed on 38 neonates and infants diagnosed with spina bifida.
- Patients were categorized based on spina bifida type: myelomeningocele (18 cases) and spina bifida occulta with lipoma (20 cases).
- Bladder compliance, pressure patterns, and upper tract status were assessed.
Main Results:
- Abnormal cystometric findings were prevalent in infants with myelomeningocele (15/18), with 8 exhibiting a low-compliance, high-pressure pattern indicative of potential upper tract deterioration.
- In spina bifida occulta cases, 5/20 showed abnormal cystometry, and 1/4 with a concerning pressure pattern received clean, intermittent catheterization.
- Clean, intermittent catheterization was initiated in 3 myelomeningocele cases and 1 spina bifida occulta case.
Conclusions:
- Cystometric examination is a simple, valuable tool for assessing neurogenic bladder function in infants with spina bifida.
- This modality aids in predicting future upper urinary tract deterioration.
- It effectively guides the selection of appropriate treatments, including clean, intermittent catheterization.
Abstract:
We examined 38 neonates and infants with spina bifida using cystometry and cystography. Among 18 cases with myelomeningocele, only 1 case was evaluated as normal, 15 cases were abnormal on cystometry and 2 cases were unable to be evaluated. In the 15 abnormal cases, 8 had low-compliance and high pressure pattern which suggested future deterioration of upper urinary tract. Clean, intermittent catheterization was started in 3 cases. In 20 cases with spina bifida occulta associated with lipoma, 14 were evaluated as normal but 5 were abnormal and 1 case was unable to be evaluated. One of the 4 cases with low-compliance and high pressure was treated with clean, intermittent catheterization. Cystometric examination is a simple and useful modality in neonates and infants with neurogenic bladder not only to evaluate the function but also to predict the future deterioration of the upper tract, and to select the proper treatment.