Summary
Purpose
Patients with spina bifida require urologic follow up with assessments of bladder
and renal function. The ideal screening protocol for bladder compliance remains controversial.
This study assessed associations between bladder end filling pressure (EFP) and detrusor
leak point pressure (DLPP) on urodynamic studies (UDS) and findings from renal bladder
ultrasounds (RBUS) and voiding cystourethrograms (VCUG).
Methods
Pediatric spina bifida patients who underwent RBUS and/or VCUG within six months of
UDS at a single institution from 2015 to 2021 were retrospectively reviewed. Demographics,
VCUG and RBUS results, and UDS EFP and DLPP were recorded. Multiple linear regression
analyses and Pearson chi-square tests were conducted to correlate RBUS and VCUG findings
with DLPP/EFP.
Results
129 patients were included. In adjusted analyses, moderate to severe hydronephrosis
on RBUS was significantly associated with elevations in mean DLPP/EFP (p = 0.006).
Patients with round bladders had significantly lower mean DLPP/EFP than patients with
elongated or conical bladders (p < 0.0001). The presence of trabeculations was associated
with increased mean DLPP/EFP (p < 0.0001) and increases in severity of trabeculations
were associated with higher DLPP/EFP (p < 0.0001). The presence of vesicoureteral
reflux (VUR) on VCUG was not associated with significant differences in mean DLPP/EFP
(p = 0.20).
Conclusions
Summary TableUnadjusted and age- and sex-adjusted linear regression analyses indicating the associations
between UDS mean DLPP/EFP and RBUS, VCUG, and eGFR findings among 129 pediatric spina
bifida patients.
| Unadjusted | Adjusted for age and sex | |||
|---|---|---|---|---|
| Estimate (95% CI) | p-value | Estimate (95% CI) | p-value | |
| Evidence of Hydronephrosis (vs. none) | 5.7 (−0.2–11.5) | 0.06 | 8.4 (2.6–14.2) | 0.005 |
| Mild (Gr 1–2) | 3.9 (−2.8–10.5) | 0.25 | 6.3 (−0.3–13.0) | 0.06 |
| Moderate-Severe (Gr 3–4) | 9.4 (0.4–18.3) | 0.04 | 12.4 (3.7–21.1) | 0.006 |
| Evidence of VUR | 4.3 (−3.6–12.1) | 0.28 | 5.0 (−2.7–12.7) | 0.20 |
| Bladder Shape (vs. round)rowhead Non-round |
16.4 (10.8–22.0) | <0.0001 | 15.5 (9.6–21.5) | <0.0001 |
| Evidence of Trabeculations | 14.2 (8.2–20.2) | <0.0001 | 13.5 (7.1–19.8) | <0.0001 |
| Bladder neck on voiding (vs. open) | ||||
| Closed | −2.9 (−10.6–4.8) | 0.45 | −4.2 (−9.8–7.0) | 0.41 |
| Open with closed sphincter | 0.9 (−7.0–8.7) | 0.83 | −1.4 (−9.8–7.0) | 0.74 |
| eGFR per 10-unit increase | −0.6 (−1.4–0.1) | 0.10 | −0.7 (−1.5–0.0) | 0.06 |
MeSH Key Words
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Article info
Publication history
Published online: October 17, 2022
Accepted:
October 14,
2022
Received in revised form:
October 4,
2022
Received:
May 31,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
