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Bladder management in children with transverse myelitis.
Arthi Hannallah1, Niccolo Passoni2, Craig A Peters2
1Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Journal of Pediatric Urology
|May 5, 2021
Summary
In children with transverse myelitis (TM), preserved lower extremity reflexes at diagnosis predict better bladder function recovery. However, many still require long-term clean intermittent catheterization (CIC) despite neurological improvement.
Area of Science:
- Neurology
- Urology
- Pediatrics
Background:
- Transverse myelitis (TM) frequently causes urinary retention.
- Bladder function recovery in TM patients is variable, with some experiencing persistent voiding dysfunction.
Purpose of the Study:
- To identify factors predicting improved voiding function in pediatric TM patients requiring clean intermittent catheterization (CIC).
- To assess the long-term risk of persistent CIC dependence in this population.
Main Methods:
- Retrospective review of pediatric TM patients requiring CIC at presentation (1998-2018).
- Analysis of demographic and neurological factors (reflexes, motor function) for association with volitional voiding.
- Longitudinal assessment of CIC dependence.
Main Results:
- Preserved lower extremity reflexes at TM onset were the sole significant predictor of improved voiding function (p < 0.05).
- Complete lower motor neurological recovery correlated with volitional voiding (p < 0.05).
- 62% of patients achieved volitional voiding, but 60% remained CIC-dependent at 1 year; cumulative risk at 10 years was 42%.
Conclusions:
- Intact reflexes in pediatric TM patients with urinary retention indicate better urologic recovery.
- Complete neurological recovery is linked to regaining volitional voiding.
- A significant proportion of pediatric TM patients require long-term CIC, necessitating ongoing monitoring.
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