The role of occult spinal malformation and upper urinary tract deterioration in children with intractable voiding dysfunction
Objectives: To evaluate the presence of upper urinary tract
deterioration (UUTD) and accompanying pathologies in children
treated with the diagnosis of non-neurogenic bladder-sphincter
Patients and Methods: We retrospectively reviewed the
medical records of 316 consecutive patients with NNBSD
who were treated. All cohort were grouped into two: Group I
(Treatment success; n=284), Group II (Treatment failure with any
form of occult spinal pathology; n=32). Thirty-four children with
treatment-failure and normal magnetic resonance imaging (MRI)
findings were excluded. Groups were compared for pre- and posttreatment
pediatric lower urinary tract symptom score (PLUTSS),
presence of UUTD and urodynamic findings.
Results: The mean PLUTSS was significantly less in Group I
compared with Group II at pre-treatment and 3 months thereafter
the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14
and 18 ± 3.4, respectively p<0.01). The mean cystometric capacities
and detrusor leak point pressure (DLPP) of Group II prior to initial
treatment and after 6 months of the untethering surgery were found
to be 194, 267 mL and 28, 12cm H2O, respectively (p<0.05).
Presence of UUTD was significantly correlated with DLPP >20 cm
H2O and presence of vesicoureteral reflux (VUR).
Conclusion: UUTD in NNBSD is more common in children
with occult spinal pathology, than in those without.
Keywords: Non-neuropathic bladder sphincter dysfunction, Upper
urinary tract deterioration, Symptom score
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