Analysis of the permanent renal injury risk factors in congenital neuropathic bladder
Gökhan Gündoğdu1, Hakan Taşkınlar2, Dinçer Avlan2, Ali Delibaş3, Bahar Taşdelen4, Ali Naycı2
1Bezmialem Vakıf Üniversitesi Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Bilim Dalı
2Mersin Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalı
3Mersin Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Anabilim Dalı, Nefrolojisi Bilim Dalı
4Mersin Üniversitesi Tıp Fakültesi Biyoistatistik Anabilim Dalı
Keywords: Spinal dysraphism, neurogenic bladder, kidney, urodynamics
Abstract
Aim: Renal function is the most important factor determining the life span in children born with congenital spinal dysraphism (SD). In the present study, we aimed to investigate factors associated with renal parenchymal injury in children with SD.
Material and Methods: Renal parenchymal injury was investigated by dimercapto succinic aciol scintigraphy (DMSA) in 80 children with SD. Age, gender, vesicoureteral reflux (VUR), recurrent urinary tract infections (UTI), detrusor leak point pressure (DLPP), neurogenic bladder treatment and its onset time were the questioned parameters with the renal injury.
Results: Records of 38 male, 42 female children were investigated retrospectively. Mean age was 66.7±28.2 months (2-204 m). Mean follow up time was 20.5±9.4 months. The diagnoses were myelomeningocele, tethered chord syndrome, diastometamyelia, sacral agenesia, renal syringomyelia; retrospectively. Renal injury was detected at 18 (22.5 %) children. VUR, UTI, neurogenic bladder treatment and age of treatment onset had statistically significance with the renal injury (p values were; <0.001, 0.001, 0.016, 0.013 retrospectively). DLPP over 40 cmH2 O increased injury risk 1.952 times but statistically significance was not found (p=0,213). Onset time of treatment had increased the risk of injury 1.013 times with every one month.
Conclusion: VUR, recurrent UTI and delay of neurogenic bladder treatment in the risk group children are factors associated with the renal injury in neuropathic bladder children.