Risk factors predicting upper urinary tract deterioration in children with spinal cord injury

Abstract

The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). Methods: The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. Results: Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH 2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. Conclusion: Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH 2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.

Activation of the TGF-β1/Smads/α-SMA pathway is related to histological and functional changes in children with neurogenic bladder

“…After summarizing the bladder function parameters of 10 children with NB, we found that the maximum cystometric capacity (MCC), bladder volume ratio (BVR), compliance (△C), maximum flow rate (Qmax), bladder contraction index (BCI), and bladder voiding efficiency (BVE) values were lower than the normal range, while the maximum detrusor pressure during filling (maxPdet) and postvoid residual (PVR) values were significantly higher (Table 1 ) 13 – 17 . Analysis of the correlation between the expression of α-SMA and bladder function parameters revealed that the expression of α-SMA was negatively correlated with the BVR (r = − 0.7066, p < 0.05) and △C (r = − 0.6516, p < 0.05) (Table 1 , Fig.…”

“…Weak bladder contractile function, a low urine flow rate and a large residual urine volume were observed during the voiding phase. These changes will prohibit the effective elimination of urine from the body and increase the risk of upper urinary tract damage 13 . This suggests that changes in bladder function should be prevented in a sufficient amount of time to reduce upper urinary tract damage.…”

“…All children with NB were subjected to a urodynamic study (UDS) in an awake state before surgery. The bladder function parameters assessed included the maximum cystometric capacity (MCC), bladder volume ratio (BVR), compliance (△C), maximum detrusor pressure during filling (maxPdet), maximum flow rate (Qmax), detrusor pressure at maximum flow rate (PdetQmax), postvoid residual (PVR), bladder contraction index (BCI), and bladder voiding efficiency (BVE), where BVR = MCC/EBV 13 . BCI = PdetQmax + 5Qmax 14 .…”

Maximal detrusor pressure can be predicted using technetium-99m-mertcaptoacetyltriglycine renal scintigraphy in the early stages of spinal cord injury

“…The optimal value was determined to be 64.05%, with a sensitivity of 1.000 and speci city of 0.429. Elevated detrusor pressure is a well-known risk factor for upper urinary tract deterioration in individuals with SCI [20][21][22][23]. The intramural ureters traverse between the bladder submucosa and the detrusor muscle before opening into the bladder.…”

“…Many studies have investigated the risk factors for upper urinary tract deterioration in individuals with SCI. In particular, high detrusor pressure is an independent factor for upper urinary tract deterioration in in individuals with SCI [20][21][22][23]. However, no previous study has investigated the relationship between 99mTc-MAG-3 renal scintigraphy ndings and detrusor pressure.…”