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Kwon, Park, Park, Han, and Kim: Risk Factors for Upper Urinary Tract Deterioration in Children with Neurogenic Bladder
Original Article
Pediatric Urology
Korean Journal of Urology

Korean Journal of Urology 2009; 50(12): 1248-1252.

Published online: 18 December 2009

DOI: https://doi.org/10.4111/kju.2009.50.12.1248

Risk Factors for Upper Urinary Tract Deterioration in Children with Neurogenic Bladder

Taekmin Kwon, Junsoo Park, Myung-Chan Park, Ji-Yeon Han, Kun Suk Kim

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Kun Suk Kim. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 137-736, Korea. TEL: 02-3010-3736, FAX: 02-477-8928, kskim2@amc.seoul.kr

Received 1 July 2009       Accepted 20 October 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

We evaluated the risk factors for upper urinary tract deterioration in children with neurogenic bladder.

Materials and Methods

The study population consisted of 60 children (36 boys, 24 girls) with neurogenic bladder confirmed by urodynamic study between January 1994 and June 2007. The average follow-up period was 48 months. The patients' medical records were assessed concerning gender, presence of vesicoureteral reflux (VUR), hydronephrosis, type of spinal dysraphism, level of spinal dysraphism, practice of clean intermittent catheterization (CIC), type of neurogenic bladder, bladder capacity, compliance, detrusor sphincter dyssynergia, recurrent urinary tract infection (UTI), and timing of primary neurosurgical repair. Upper urinary tract deterioration was diagnosed by 99m technetium-dimercaptosuccinic acid renal scan (DMSA) and aggravation of hydronephrosis and VUR.

Results

Upper urinary tract deterioration was detected in 15 patients (25%). Hydronephrosis, VUR, and UTI were associated with upper urinary tract deterioration in the univariate analyses. In the multivariate analyses, hydronephrosis [odds ratio (OR)=2.181, 95% confidence interval (CI)=1.191-11.941, p=0.036] and recurrent UTI [OR=5.810, 95% CI=1.200-28.192, p=0.029] were independent risk factors for upper urinary tract deterioration.

Conclusions

Hydronephrosis and recurrent UTI increase the risk of upper urinary tract deterioration in children and adolescents with neurogenic bladder. Therefore, intensive observation and prompt intervention may be recommended for such cases.

Keywords: Neurogenic bladder, Urinary tract, Risk factors

Figures and Tables

Table 1
Characteristics of patients with neurogenic bladder
kju-50-1248-i001

VUR: vesicoureteral reflux, CIC: clean intermittent catheterization, DSD: detrusor sphincter dyssynergia, UTI: urinary tract infection

Table 2
Univariate analyses for predicting upper tract deterioration
kju-50-1248-i002

logistic regression analysis, OR: odds ratio, CI: confidence interval, VUR: vesicoureteral reflux, CIC: clean intermittent catheterization, DSD: detrusor sphincter dyssynergia, UTI: urinary tract infection

Table 3
Multivariate analyses for predicting upper tract deterioration
kju-50-1248-i003

logistic regression analysis (backward elimination), OR: odds ratio, CI: confidence interval, UTI: urinary tract infection

Table 4
Urodynamic and clinical characteristics between patients with CIC and those without CIC
kju-50-1248-i004

CIC: clean intermittent catheterization, DSD: detrusor sphincter dyssynergia, a: chi-square test

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