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Long-term renal risk factors in children with meningomyelocele
Insights
A small, noncompliant bladder is a significant risk factor for renal deterioration in patients with meningomyelocele. Early identification and management are crucial for preserving kidney function in this population.
Area of Science:
- Pediatric Urology
- Nephrology
- Spina Bifida Research
Background:
- Meningomyelocele often leads to bladder dysfunction, increasing the risk of upper urinary tract damage.
- Long-term renal outcomes in meningomyelocele patients depend on effective bladder management strategies.
Purpose of the Study:
- To evaluate the impact of different bladder management techniques on renal function and structure in patients with meningomyelocele.
- To identify risk factors associated with renal deterioration in this patient cohort.
Main Methods:
- Retrospective study of 42 meningomyelocele patients (28 intermittent catheterization, 14 ileal loop diversion) over 60 months.
- Assessment of renal function and structure using intravenous pyelogram and voiding cystourethrography.
- Analysis of bacteriuria rates and correlation with bladder characteristics and renal outcomes.
Main Results:
- Ileal loop diversion patients had higher rates of ureteral reflux and bacteriuria compared to intermittent catheterization.
- 14% of intermittent catheterization patients and 28% of ileal loop diversion patients experienced renal changes.
- Small, noncompliant, trabeculated bladders were strongly associated with worsening renal function (P < 0.01).
Conclusions:
- A small, noncompliant, trabeculated bladder is a key risk factor for renal function loss in meningomyelocele.
- Bladder characteristics, rather than neurologic level, are critical predictors of renal health.
- Optimizing bladder management is essential for preventing renal complications in meningomyelocele.
Abstract:
We studied renal function and structure in 42 patients with meningomyelocele, 28 treated with intermittent catheterization and 14 with ileal loop diversion. Patients were observed for a minimum of 60 months. Nine of the 28 patients who underwent intermittent catheterization had evidence of unilateral or bilateral reflux, and all patients with ileal loop diversion had free ureteral reflux. Bacteriuria was present in 38% +/- 5% of cultures obtained from patients with catheterization and in 70% +/- 7% of cultures from those with diversion (P less than 0.001). Four (14%) of 28 patients with catheterization had worsening renal function or anatomic appearance by intravenous pyelogram, and required a diversion. Three (28%) of 14 patients with diversion had changes in renal structure or function. Eight of 31 patients from both groups studied with voiding cystourethrography before the onset of therapy had small, noncompliant, trabeculated bladders; all seven patients who had worsening in function or anatomic appearance were from this subset (P less than 0.01). None of the patients with flaccid or distensible bladders demonstrated these changes. Renal disease was unrelated to the level of neurologic function. A small, noncompliant, trabeculated bladder is a risk factor associated with loss of renal function in patients with meningomyelocele.