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Imaging characteristics predicting elevated detrusor pressures in patients with spina bifida

Published:October 17, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.021

      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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