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Development of hydronephrosis in spina bifida patients: predictive factors and management
1Department of Urology, Dalhousie University, Izaak Walton Killam Children's Hospital, Halifax, Canada.
Insights
Spina bifida patients with higher spinal defects or in specific age groups face increased hydronephrosis risk. Management, often involving clean intermittent catheterisation, yielded satisfactory outcomes in 82% of cases.
Area of Science:
- Pediatric Urology
- Nephrology
- Developmental Biology
Background:
- Spina bifida is a congenital condition impacting neural tube development, often leading to urinary tract complications.
- Hydronephrosis, or swelling of the kidney due to urine backup, is a significant concern in children with spina bifida.
Purpose of the Study:
- To identify predictive factors for hydronephrosis development in pediatric spina bifida patients.
- To evaluate the effectiveness of various management strategies for hydronephrosis in this population.
Main Methods:
- A retrospective review of 209 children diagnosed with spina bifida.
- Analysis of renal sonography findings to detect hydronephrosis.
- Correlation of hydronephrosis with spinal defect level and patient age.
Main Results:
- Hydronephrosis was observed in 48% of the reviewed cases.
- Higher spinal defect levels and specific age periods (infancy and teenage years with CIC) were identified as significant risk factors.
- Clean intermittent catheterisation (CIC), with or without anticholinergic medication, was the primary treatment, achieving satisfactory outcomes in 82% of treated patients.
Conclusions:
- Renal sonography is an effective screening tool for detecting upper urinary tract changes in spina bifida.
- Early identification and management of risk factors, particularly spinal level and age, are crucial for preventing or treating hydronephrosis.
- Multimodal treatment approaches, including CIC, are effective in managing hydronephrosis in spina bifida patients.
Abstract:
A retrospective review of 209 children with spina bifida was performed to determine predictive factors for the development of hydronephrotic changes and to assess the outcome of management. Renal sonography demonstrated hydronephrosis in 100 cases (48%). Two risk factors were identified: level of spinal defect and age of the patient. Higher spinal levels carried the greatest risk of hydronephrosis. The high risk age periods were the first 4 months of life, affecting children with high lesions, and the teenage years, affecting those on clean intermittent catheterisation (CIC). Seventy-nine hydronephrotic patients underwent treatment, whereas for 21 there was improvement in the sonographic appearance without intervention. CIC with or without anticholinergic pharmacotherapy was the most common treatment (58%), but often a combination of modalities was required to achieve improvement. The final result of all treatments was deemed satisfactory in 82% of cases. Renal sonography was a useful screening tool to detect upper tract changes in spina bifida patients.