Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida

Adam J. Rensing, Konrad Szymanski, Rosalia Misseri, Joshua D. Roth, Shelly King, Katherine Chan, Benjamin Whittam, Martin Kaefer, Richard C. Rink, Mark P. Cain

Research output: Contribution to journalArticle

Abstract

Background: Spina bifida (SB) patients are at increased risk for hydronephrosis, bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries. Methods: We retrospectively reviewed patients born with SB 2005–2009, presenting to our institution within 1 year of birth. Outcomes at 8–11 years old included final renal/bladder ultrasound (RBUS) results, clean intermittent catheterization (CIC) use, anticholinergic use, surgical interventions, and final renal function. We excluded those without follow-up past age 8 and/or no RBUS or fluoroscopic urodynamic images (FUI) within the first year of life. Imaging was independently reviewed by four pediatric urologists blinded to radiologists’ interpretation and initial findings compared with final outcomes. Results: Of 98 children, 62 met inclusion criteria (48% male, 76% shunted). Median age at last follow-up was 9.6 years. Upon initial imaging, 74% had hydronephrosis (≥ SFU grade 1), decreasing to 5% at 10 years (p < 0.0001). Initially, 9% had ≥ SFU grade 3 hydronephrosis, decreasing to 2% (p = 0.13). CIC and anticholinergic use increased from 61% and 37% to 87% and 86%, respectively (p = 0.001 and p < 0.0001, respectively). With follow-up, 55% had surgical intervention and 23% had an augmentation. Of children with a serum creatinine/cystatin-C at 8–11 years old, one had confirmed chronic kidney disease (stage 2). Conclusions: Despite initial high incidence of hydronephrosis, this was low grade and resolved in the first decade of life. Additionally, the 8–11-year incidence of kidney disease and upper tract changes was low due to aggressive medical management.

Original languageEnglish (US)
JournalPediatric Nephrology
DOIs
StatePublished - Jan 1 2019

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Spinal Dysraphism
Hydronephrosis
Urinary Bladder
Intermittent Urethral Catheterization
Cholinergic Antagonists
Kidney
Cystatin C
Urodynamics
Incidence
Kidney Diseases
Chronic Renal Insufficiency
Renal Insufficiency
Creatinine
Parturition
Pediatrics
Serum

Keywords

  • Children
  • CKD
  • Clean intermittent catheterization
  • Hydronephrosis
  • Outcome
  • Spina bifida
  • Surgical intervention

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida. / Rensing, Adam J.; Szymanski, Konrad; Misseri, Rosalia; Roth, Joshua D.; King, Shelly; Chan, Katherine; Whittam, Benjamin; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

In: Pediatric Nephrology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Spina bifida (SB) patients are at increased risk for hydronephrosis, bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries. Methods: We retrospectively reviewed patients born with SB 2005–2009, presenting to our institution within 1 year of birth. Outcomes at 8–11 years old included final renal/bladder ultrasound (RBUS) results, clean intermittent catheterization (CIC) use, anticholinergic use, surgical interventions, and final renal function. We excluded those without follow-up past age 8 and/or no RBUS or fluoroscopic urodynamic images (FUI) within the first year of life. Imaging was independently reviewed by four pediatric urologists blinded to radiologists’ interpretation and initial findings compared with final outcomes. Results: Of 98 children, 62 met inclusion criteria (48{\%} male, 76{\%} shunted). Median age at last follow-up was 9.6 years. Upon initial imaging, 74{\%} had hydronephrosis (≥ SFU grade 1), decreasing to 5{\%} at 10 years (p < 0.0001). Initially, 9{\%} had ≥ SFU grade 3 hydronephrosis, decreasing to 2{\%} (p = 0.13). CIC and anticholinergic use increased from 61{\%} and 37{\%} to 87{\%} and 86{\%}, respectively (p = 0.001 and p < 0.0001, respectively). With follow-up, 55{\%} had surgical intervention and 23{\%} had an augmentation. Of children with a serum creatinine/cystatin-C at 8–11 years old, one had confirmed chronic kidney disease (stage 2). Conclusions: Despite initial high incidence of hydronephrosis, this was low grade and resolved in the first decade of life. Additionally, the 8–11-year incidence of kidney disease and upper tract changes was low due to aggressive medical management.",
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AU - Rensing, Adam J.

AU - Szymanski, Konrad

AU - Misseri, Rosalia

AU - Roth, Joshua D.

AU - King, Shelly

AU - Chan, Katherine

AU - Whittam, Benjamin

AU - Kaefer, Martin

AU - Rink, Richard C.

AU - Cain, Mark P.

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AB - Background: Spina bifida (SB) patients are at increased risk for hydronephrosis, bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries. Methods: We retrospectively reviewed patients born with SB 2005–2009, presenting to our institution within 1 year of birth. Outcomes at 8–11 years old included final renal/bladder ultrasound (RBUS) results, clean intermittent catheterization (CIC) use, anticholinergic use, surgical interventions, and final renal function. We excluded those without follow-up past age 8 and/or no RBUS or fluoroscopic urodynamic images (FUI) within the first year of life. Imaging was independently reviewed by four pediatric urologists blinded to radiologists’ interpretation and initial findings compared with final outcomes. Results: Of 98 children, 62 met inclusion criteria (48% male, 76% shunted). Median age at last follow-up was 9.6 years. Upon initial imaging, 74% had hydronephrosis (≥ SFU grade 1), decreasing to 5% at 10 years (p < 0.0001). Initially, 9% had ≥ SFU grade 3 hydronephrosis, decreasing to 2% (p = 0.13). CIC and anticholinergic use increased from 61% and 37% to 87% and 86%, respectively (p = 0.001 and p < 0.0001, respectively). With follow-up, 55% had surgical intervention and 23% had an augmentation. Of children with a serum creatinine/cystatin-C at 8–11 years old, one had confirmed chronic kidney disease (stage 2). Conclusions: Despite initial high incidence of hydronephrosis, this was low grade and resolved in the first decade of life. Additionally, the 8–11-year incidence of kidney disease and upper tract changes was low due to aggressive medical management.

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KW - Outcome

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KW - Surgical intervention

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