Evaluation of urinary system findings in children with spinal dysraphism

Abstract

Purpose: It was aimed to evaluate the frequency of kidney damage and possible risk factors by retrospectively evaluating the urinary system findings of pediatric patients followed up for 'spinal dysraphism' in Pamukkale University Pediatric Nephrology Clinic.
Materials and methods: The data of pediatric patients who were followed up with the diagnosis of neurogenic bladder due to spinal dysraphism between January 2014 and August 2021 were evaluated retrospectively. Demographic and clinical characteristics of the patients, whether they received clean intermittent catheter (CIC) treatment, if so, when to start and at the last follow-up, urinary system ultrasound findings (hydronephrosis and bladder wall thickness), presence of vesicoureteral reflux (VUR), dimercaptosuccinic acid scintigraphy findings, according to Shwartz Glomerular filtration rate (eGFR) levels were recorded.
Results: A total of 44 patients, 17 male and 27 female, were included in the study. The mean age was 7.2±4.2 years. Twenty (45.5%) of the children were followed for more than 5 years. Among the cases, meningomyelocele (88.6%) was found to be the most common defect. There were only 2 patients who did not undergo surgery for spinal dysraphism. Approximately 90% of the cases were operated before 1 year of age. Approximately 40% of the patients were found to have kidney damage on DMSA scintigraphy, 52% had hydronephrosis, and approximately 16% had low eGFR. In urodynamic findings, 18 (40.9%) patients had high pressure bladder (bladder pressure >40 cmH2O), 11 (25%) patients had areflex bladder, 13 (29.5%) patients had normal urodynamic findings. Fifteen (34.1%) patients had VUR. There was no significant relationship between operation time, age at onset of CIC, tethered cord development and kidney damage.
Conclusion: The main goal in the management of urological problems in patients with spinal dysraphism is the protection of the upper urinary tract. Although there are suggestions for early diagnosis and treatment of urological problems in these patients, the management of these patients is still controversial and difficult.

Keywords

• Spinal dysraphism
• neurogenic bladder
• child
• meningomyelocele

Spinal disrafizmli çocuklarda üriner sistem bulgularının değerlendirilmesi

Öz

Amaç: Bu çalışmada Pamukkale Üniversitesi Çocuk Nefroloji Kliniği’nde ‘spinal disrafizm' nedeniyle izlenen çocuk hastaların üriner sistem bulgularının retrospektif olarak değerlendirilerek, böbrek hasarı sıklığı ve olası risk faktörlerini değerlendirmek amaçlanmıştır.
Gereç ve yöntem: Ocak 2014 ile Ağustos 2021 tarihleri arasında ‘spinal disrafizme bağlı nörojen mesane’ tanısı ile izlenen çocuk hastaların verileri retrospektif olarak değerlendirildi. Hastaların demografik ve klinik özellikleri, temiz aralıklı katater (TAK) tedavisi alıp almadığı, alıyorsa başlanma zamanı ve son kontroldeki üriner sistem ultrasanografi bulguları (hidronefroz ve mesane duvar kalınlığı), vezikoüreteral reflü (VUR) varlığı, Dimerkaptosüksinik asit (DMSA) sintigrafi bulguları, Shwartz’a göre tahimini glomeruler filtrasyon hızı (eGFR) düzeyleri kayıt edildi.
Bulgular: Çalışmaya 17 erkek, 27 kız olmak üzere toplam 44 hasta dahil edildi. Ortalama yaş 7,2±4,2 yaş olarak bulundu. Çocukların 20’si (%45,5) 5 yıldan uzun süredir takip edilmekteydi. Olgular arasında meningomyelosel (%88,6) en çok saptanan defekt olarak bulundu. Spinal disrafizme yönelik operasyon geçirmeyen sadece 2 hasta vardı. Olguların yaklaşık %90’ı 1 yaşından önce opere edilmişti. Hastaların yaklaşık %40’ında DMSA sintigrafide böbrekte hasar, %52’sinde hidronefroz, yaklaşık %16’sında ise eGFR’nin düşük olduğunu saptandı. Ürodinami bulgularında 18 (%40,9) hastada yüksek basınçlı mesane (mesane basıncı >40 cmH2O), 11 (%25) hastada arefleks mesane, 13 (%29,5) hastada normal ürodinami bulguları vardı. Onbeş (%34,1) hastada VUR vardı. Operasyon zamanı, TAK başlama yaşı ve gergin kord gelişimi ile böbrekte hasarlanma arasında anlamlı ilişki saptanmadı.
Sonuç: Spinal disrafizm hastalarının ürolojik problemlerinin yönetiminde temel hedef üst üriner sistemin korunmasıdır. Bu hastalarda ürolojik problemlerin erken tanınıp tedavilerin başlanması yönünde öneriler olsa da halen bu hastaların yönetimi tartışmalı ve zordur.

Anahtar Kelimeler

• Spinal disrafizm
• nörojen mesane
• çocuk
• meningomiyelosel

Kaynakça

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