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The long-term urological response of neonates with myelodysplasia treated proactively with intermittent
R A Edelstein1, S B Bauer, M D Kelly
1Division of Urology, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Proactive bladder management, including intermittent catheterization, significantly reduces urinary tract deterioration in children with myelodysplasia. This approach prevents upper urinary tract damage and the need for surgery.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Spina Bifida Research
Background:
- Management of urinary tract issues in pediatric myelodysplasia is debated.
- Some recommend observation, while others favor early intervention.
Purpose of the Study:
- To compare urological outcomes in children at risk for deterioration.
- To evaluate the efficacy of prophylactic intermittent catheterization and anticholinergic therapy.
Main Methods:
- A prospective, nonrandomized study observed children with bladder-sphincter dyssynergia or high bladder pressures.
- Children were either observed or treated proactively with intermittent catheterization +/- anticholinergics.
Main Results:
- 35 of 44 children (79.5%) under observation experienced urinary tract deterioration.
- Only 3 of 20 children (15%) treated proactively with intermittent catheterization showed deterioration.
Conclusions:
- Proactive bladder management significantly decreases upper urinary tract deterioration.
- Early intervention reduces the need for surgical procedures in pediatric myelodysplasia patients.
Purpose:
Urinary tract management in children with myelodysplasia is controversial. Some advocate observation alone, while others believe that the prophylactic institution of intermittent catheterization and anticholinergic therapy may help to prevent deterioration.
Materials And Methods:
A nonrandomized prospective study was instituted to compare the urological outcomes of a cohort of children who were at risk for urological deterioration on the basis of bladder-sphincter dyssynergia and/or high filling or voiding pressures. Those at risk were observed until deterioration occurred, or were placed on prophylactic intermittent catheterization with or without anticholinergic medication.
Results:
Of 44 children at risk 35 followed by observation alone had urinary tract deterioration, whereas only 3 of 20 at risk treated with prophylactic intermittent catheterization had deterioration with time.
Conclusions:
Proactive bladder treatment significantly reduced the incidence of upper urinary tract deterioration and need for surgical intervention.