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Urodynamic score in children with lipomyelomeningocele: a prospective study
Gëzim Dushi1, Peter Frey, Pascal Ramseyer
1Department of Pediatric Surgery, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
Insights
The urodynamic score effectively monitors children with lipomyelomeningocele, correlating well with symptom presence. This tool aids in managing these complex pediatric cases.
Area of Science:
- Pediatric Urology
- Neurology
- Medical Diagnostics
Background:
- Lipomyelomeningocele is a congenital spinal cord malformation.
- Urinary dysfunction is a common complication in children with lipomyelomeningocele.
- Effective monitoring is crucial for managing potential complications.
Purpose of the Study:
- To evaluate the correlation between urodynamic score and symptoms in children with lipomyelomeningocele.
- To assess the utility of urodynamic scoring for monitoring these patients.
- To inform surgical and conservative management decisions.
Main Methods:
- Prospective evaluation of 29 children (age 1 month to 13 years) with lipomyelomeningocele.
- Assignment of a 4-parameter urodynamic score (0-17) at diagnosis and follow-up.
- Categorization into symptomatic and asymptomatic groups, with further division based on management (surgical vs. conservative).
Main Results:
- All symptomatic children had abnormal urodynamic scores; 55% showed improvement post-surgery.
- Asymptomatic children also exhibited abnormal scores; 86% improved after surgery.
- Conservative management in asymptomatic cases revealed late urodynamic deterioration in 27% despite remaining symptom-free.
Conclusions:
- Urodynamic score is a valuable tool for monitoring children with lipomyelomeningocele.
- The score demonstrates a strong correlation with the presence and progression of symptoms.
- This scoring system aids in timely intervention and management adjustments.
Purpose:
We assessed the correlation between urodynamic score and presence of symptoms in children with lipomyelomeningocele, and the usefulness of this measure in monitoring these children.
Materials And Methods:
We prospectively evaluated 29 patients 1 month to 13 years old (mean 1.9 years) with lipomyelomeningocele from 1995 to 2010. A 4-parameter urodynamic score ranging from 0 to 17 was assigned to each patient at diagnosis and followup. Indications for surgery were presence of symptoms and signs or abnormal urodynamic score. Children were divided into 2 groups, symptomatic and asymptomatic. The latter group was further divided into operated and conservatively managed cases. Average followup was 6.7 years (range 2 to 16).
Results:
The symptomatic group contained 11 children (38%) operated on at a mean age of 2.9 years. Mean followup was 6.7 years (range 2 to 12). All patients presented with an abnormal urodynamic score. Postoperative urodynamic score improved in 6 patients (55%), remained abnormal in 4 (36%) and deteriorated in 1 (9%). The asymptomatic group contained 18 patients, of whom 7 (39%) were operated on at a mean age of 1.4 years. Mean followup was 10 years (range 3 to 16). Postoperative score improved in 6 patients (86%) and remained unchanged in 1 (14%). A total of 11 cases (61%) were managed conservatively, with a mean followup 4.3 years (range 2 to 7). Of these patients 3 (27%) presented with late urodynamic score deterioration at 3, 5 and 6 years of followup while remaining asymptomatic.
Conclusions:
Urodynamic score is a useful tool in monitoring children with lipomyelomeningocele because it has a good correlation with the presence of symptoms.
