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Long-term urodynamic follow up in pediatric spinal cord injury
Insights
Pediatric spinal cord injuries (SCIs) are rare. Aggressive follow-up, including renal ultrasound and video urodynamics, preserves urinary tract function in most children with SCI.
Area of Science:
- Pediatric Neurology
- Urology
- Rehabilitation Medicine
Background:
- Spinal cord injuries (SCIs) are infrequent in children, representing less than 5% of all cases.
- This study focuses on a cohort of 40 pediatric patients with SCI managed at a single medical center.
Purpose of the Study:
- To evaluate the long-term urinary tract function and management outcomes in children with SCI.
- To establish recommendations for optimal follow-up protocols to prevent complications.
Main Methods:
- Retrospective review of 40 pediatric patients with SCI (ages 0-17 years) with a mean follow-up of 46.1 months.
- Analysis of bladder management strategies, including reflex voiding, anticholinergic medication, and intermittent catheterization.
- Assessment of urinary tract preservation using video urodynamics and upper tract surveillance (intravenous pyelogram, renal ultrasound).
Main Results:
- Twenty-eight patients with over 1 year of follow-up showed good urinary tract function and preservation in 25 (89%).
- Treatment failures were primarily linked to noncompliance with prescribed voiding regimens.
- All patients with anatomically normal lower tracts demonstrated preserved upper tracts during surveillance.
Conclusions:
- Aggressive, long-term monitoring is crucial for managing bladder function in pediatric SCI.
- Yearly renal ultrasound and biennial video urodynamics are recommended for surveillance.
- Adherence to voiding regimens is critical for preventing treatment failures and preserving urinary tract health.
Abstract:
Less than 5% of all spinal cord injuries occur in children under 16 years of age. We have followed up 40 children with spinal cord injury at our medical center. The patients have an average age at presentation of 9.0 years (range newborn to 17 years) and have a mean follow up of 46.1 months (range 1 to 240 months). Twenty-two patients have cervical injuries, 13 thoracic and five have lumbar injuries. Bladder management in this group includes 11 patients with reflex voiding and 29 patients combining anticholinergic medication with intermittent catheterization. Twenty-eight patients have a follow up for more than 1 year. Review of the video urodynamics in this group has shown good function and preservation of the urinary tract in 25 of 28 patients. Treatment failures can be attributed to noncompliance with recommended voiding regimens. Upper tract surveillance using intravenous pyelogram or renal ultrasound has shown preservation of the upper tracts in all patients with anatomically normal lower tracts. We recommend aggressive follow up in this group of patients with yearly renal ultrasound and video urodynamics every 1-2 years to monitor urinary tract function.