Related Experiment Videos
Urodynamic predictors of upper tract deterioration in children with myelodysplasia
M S Shoukry1, S El Salmy, G A Aly
1Department of Urology, Alexandria University, Egypt.
Insights
Predicting upper tract deterioration in children with myelodysplasia is possible using specific urodynamic parameters. Residual urine and leak pressure, along with detrusor pressure at peak flow, offer valuable predictive insights.
Area of Science:
- Pediatric Urology
- Nephrology
- Developmental Biology
Background:
- Myelodysplasia often leads to neurogenic bladder dysfunction.
- Upper tract deterioration is a significant complication in children with myelodysplasia.
- Early prediction of upper tract damage is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and urodynamic predictors of upper tract deterioration in children with myelodysplasia.
- To compare urodynamic parameters between children with and without upper tract dilation.
Main Methods:
- Statistical analysis of clinical and urodynamic data from 62 children with myelodysplasia.
- Comparison of data between a group with dilated upper tracts (n=26) and a group with normal upper tracts (n=36).
Main Results:
- Vesicoureteric reflux strongly correlated with upper tract dilation.
- Maximum cystometric capacity, detrusor instability, compliance, maximum urethral closure pressure, and peak flow rate lacked predictive value.
- Residual urine (sensitive, negatively predictive) and leak pressure (specific, positively predictive) showed predictive value.
- Detrusor pressure at peak flow, opening pressure, pressure at least flow, and DAMPF demonstrated high sensitivity and specificity with strong predictive values.
Conclusions:
- Specific urodynamic parameters, including residual urine, leak pressure, and detrusor pressure metrics, can predict upper tract deterioration in myelodysplasia.
- Vesicoureteric reflux is a significant risk factor for upper tract dilation.
- Several commonly assessed urodynamic parameters have limited value in predicting upper tract damage in this population.
Abstract:
The clinical and urodynamic data of 62 children with myelodysplasia without previous urological treatment were tested statistically for the ability to predict upper tract deterioration. This was done by comparing these data among 26 children with dilated upper tracts and 36 children with normal upper tracts. Vesicoureteric reflux had a strong positive correlation with upper tract dilation but the maximum cystometric capacity, detrusor instability, compliance, maximum urethral closure pressure and peak flow rate all had no predictive value. Residual urine is sensitive and negatively predictive and leak pressure is specific and positively predictive; detrusor pressure at peak flow, opening pressure, pressure at least flow and the detrusor-adjusted mean passive urethral resistance relation factor (DAMPF) are sensitive and specific with high positive and negative predictive values.