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[Fluid loss pressure in 45 children with congenital neurogenic bladder]
C Miguelez Lago1, E Galiano Duro, J Aparicio Portero
1Hospital Materno-Infantil de Málaga, España.
Insights
Leak point pressure (LPP) in pediatric neurogenic bladder indicates upper urinary tract (UUT) status. Higher LPP correlates with increased renal impairment and renal reflux (RR), suggesting urethral obstruction impacts prognosis.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Context:
- Pediatric neurogenic bladder, often resulting from myelodysplasia, presents challenges in managing urinary function and protecting the upper urinary tract.
- Urodynamic evaluation is crucial for assessing bladder function and predicting potential complications.
Purpose:
- To investigate the relationship between leak point pressure (LPP) during the initial urodynamic assessment and the condition of the upper urinary tract (UUT) and the presence of renal reflux (RR) in children with neurogenic bladder.
- To determine if LPP can serve as a prognostic indicator for renal damage in this population.
Summary:
- This study evaluated 45 children with myelodysplastic bladder dysfunction, measuring LPP and assessing UUT status via ultrasound and RR via voiding cystography.
- Results indicated that LPP below 30 cm H2O was associated with a normal UUT, while higher LPP values (>30 cm H2O) correlated with increased rates of abnormal UUT and RR.
- Specifically, LPP > 60 cm H2O showed a 70% incidence of both abnormal UUT and RR.
Impact:
- The findings suggest that elevated LPP in pediatric neurogenic bladder signifies a higher risk of renal impairment and renal reflux, indicating a poorer prognosis.
- Clean intermittent catheterization is recommended for all patients, irrespective of age or sex, to mitigate these risks and improve outcomes.
Objective:
This study analyzed the relation between leak point pressure (LPP) at first urodynamic evaluation and the status of the upper urinary tract (UUT) and renal reflux (RR).
Methods:
The study comprised 45 myelodysplastic children, one week to 13 years of age; 19 (42%) were less than one year old. LPP was measured when liquid started to come out through the urethral meatus, around the 5-6 Fr catheter. UUT was evaluated by ultrasound and RR by voiding cystography.
Results:
19 children had LPP < 30 cm H2O; all cases had a normal UUT, although 5 (26%) had RR. Twenty-six cases (58%) had LPP > 30 cm H2O; 12 (46%) had abnormal UUT and 6 of these had RR; 7 cases had RR but normal UUT. The group with LPP > or = 30 cm H2O was analyzed according to LPP values. The UUT was abnormal in 31% of cases with LPP 30-60 cm H2O and 37% had RR; UUT was abnormal in 70% of cases with LPP > 60 cm H2O and 70% had RR. Of the 19 patients less than one year old 9 (47%) had LPP < 30 cm H2O, no patient had abnormal UUT and only two (22%) had RR; 10 cases had LPP > or = 30 cm H2O, 6 of these had abnormal UUT and 5 had RR.
Conclusions:
In this study UUT was normal when LPP was < 30 cm H2O. Renal impairment and RR increased with LPP. Urethral functional obstruction carries a worse prognosis of pediatric neurogenic bladder. In these cases clean intermittent catheterization is recommended, regardless of patient age and sex.