The role of occult spinal malformation and upper urinary tract deterioration in children with intractable voiding dysfunction

Yılören TANIDIR, Tarık Emre ŞENER, Çağrı Akın ŞEKERCİ, Ahmet ŞAHAN, Yaşar BAYRI, Bahattin TANRIKULU, İlker TİNAY, Harika ALPAY, Tufan TARCAN, Ferruh ŞİMŞEK, Cem AKBAL
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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
dysfunction (NNBSD).
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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