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Urology case report: Multifactorial bladder dysfunction in the setting of down syndrome
Yusuke Matsuura1, Jennifer Gates1, Peter Morgenstern1
1Icahn School of Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
Urology Case Reports
|December 23, 2022
Summary
A teen with Down syndrome experienced kidney issues and urinary retention. Surgical intervention for a Tarlov cyst and urethral stricture resolved kidney problems, while behavioral therapy improved bladder emptying.
Area of Science:
- Nephrology
- Urology
- Neurology
Background:
- A 16-year-old male with Down syndrome presented with acute kidney injury (AKI) and a urinary tract infection (UTI).
- Initial treatment involved meropenem for ESBL-positive *E. coli*.
- Persistent elevated creatinine and significant post-void residual (PVR) indicated underlying complications.
Observation:
- Further investigations revealed urethral stricture and a sacral Tarlov cyst.
- Urethral dilatation provided incomplete relief for the patient's urinary issues.
- Surgical intervention included laminectomy and Tarlov cyst fenestration.
Findings:
- Post-surgery, the patient's creatinine normalized, urine output increased, and urinary flow improved.
- Despite improvements, a PVR >100 mL persisted, necessitating further management.
- Behavioral therapy, including timed voiding, successfully reduced PVR to <5 mL.
Implications:
- This case highlights the complex interplay between neurological and urological conditions in patients with Down syndrome.
- Multidisciplinary management, including surgical and behavioral interventions, is crucial for addressing complex urological issues.
- Effective treatment of underlying causes like Tarlov cysts can lead to significant recovery of renal function and bladder control.
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