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Risk factors predicting upper urinary tract deterioration in children with spinal cord injury
Bülent Önal1, Elif A Kırlı1, Berin Selçuk1
1Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Insights
Children with spinal cord injury (SCI) face risks of upper urinary tract (UUT) deterioration. Key predictors include abnormal lower urinary tract (LUT) findings, iatrogenic SCI, high detrusor pressure, and low bladder volume ratio (BVR).
Area of Science:
- Pediatric Nephrology
- Urology
- Neurology
Background:
- Spinal cord injury (SCI) in children can lead to significant secondary complications.
- Upper urinary tract (UUT) deterioration is a serious concern in pediatric SCI patients.
- Understanding risk factors is crucial for timely intervention and management.
Purpose of the Study:
- To identify and analyze the risk factors associated with upper urinary tract (UUT) deterioration in pediatric patients with spinal cord injury (SCI).
Main Methods:
- Retrospective review of medical records for 108 children with SCI.
- Analysis of patient demographics, SCI characteristics, bladder management, UTIs, radiological findings (UUT and LUT), and videourodynamics.
- Receiver operating characteristic (ROC) curve analysis and multivariate regression for risk factor identification.
Main Results:
- UUT deterioration was observed in 43% of the 76 children with complete data.
- Independent risk factors identified: iatrogenic SCI etiology, abnormal radiological lower urinary tract (LUT) findings, and detrusor pressures > 70 cmH2O.
- ROC analysis determined a bladder volume ratio (BVR) < 0.7 as a significant cutoff for UUT deterioration.
Conclusions:
- Abnormal radiological LUT findings, iatrogenic SCI, high detrusor pressure (>70 cmH2O), and low BVR (<0.7) are independent risk factors for UUT deterioration in children with SCI.
- These findings highlight the importance of comprehensive urological monitoring in this population.
- Early detection and management of these risk factors can potentially prevent UUT damage.
Aim:
The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI).
Methods:
The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration.
Results:
Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI.
Conclusion:
Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.
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