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Forster CS, Kowalewski NN, Atienza M, Reines K, Ross S. Defining Urinary Tract Infections in Children With Spina Bifida: A Systematic Review. Hosp Pediatr 2021; 11:1280-1287. [PMID: 34697071 DOI: 10.1542/hpeds.2021-005934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Children with spina bifida are at high risk for urinary tract infections (UTI). However, there is no standardized definition of UTI in this population, leading to variability in both clinical management and research. This was highlighted in the 2013 systematic review on the same topic. OBJECTIVE Evaluate the frequency with which researchers are defining UTI in their studies of children with spina bifida and to determine what parameters are used. DATA SOURCES We searched Medline and Scopus databases for articles that included pediatric patients with spina bifida and used UTI as an outcome. STUDY SELECTION Exclusion criteria included publication before October 1, 2012, non-English language, and nonprimary research articles. DATA EXTRACTION Two independent reviewers each extracted data. RESULTS A total of 39 studies were included; 74% of these analyzed included an explicit definition of UTI. The most commonly used definition included a combination of symptoms and culture results (34.5%), whereas 31% used a combination of symptoms, culture results, and urinalysis data. Only 3.4% of articles used a urine culture alone to define UTI. CONCLUSIONS More articles that focus on children with spina bifida included a definition of UTI. However, significant variability persists in the definition of UTI in this patient population.
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Affiliation(s)
- Catherine S Forster
- Children's National Hospital, Washington, District of Columbia .,The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | | | - Matthew Atienza
- The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Katy Reines
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sherry Ross
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Chu DI, Balmert LC, Chen L, Arkin C, Meyer T, Rosoklija I, Bowen DK, Hodgkins KS, Bowman RM, Cheng EY, Yerkes EB, Isakova T. Diagnostic Test Characteristics of Ultrasound Based Hydronephrosis in Identifying Low Kidney Function in Young Patients with Spina Bifida: A Retrospective Cohort Study. J Urol 2021; 205:1180-1188. [PMID: 33207136 PMCID: PMC7946739 DOI: 10.1097/ju.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Kidney dysfunction in spina bifida is usually detected by low estimated glomerular filtration rate or ultrasound based hydronephrosis. We assessed the diagnostic test characteristics of hydronephrosis for detecting low estimated glomerular filtration rate, hypothesizing that hydronephrosis has low sensitivity compared to cystatin C based estimated glomerular filtration rate. MATERIALS AND METHODS We conducted a single center, retrospective cohort study, including patients with spina bifida from 2012-2017 with 2 kidneys and complete data needed to calculate estimated glomerular filtration rate via multiple pediatric (age 1-17.9 years) or adult (age ≥18 years) estimating equations. We evaluated the association of hydronephrosis status (high grade, low grade or none) with estimated glomerular filtration rate, adjusting for small kidney size and scarring, and calculated diagnostic test characteristics of hydronephrosis for low estimated glomerular filtration rate. RESULTS We analyzed 247 patients (176 children and 71 adults). Mean±SD age was 13.7±6.6 years, and 81% of patients had myelomeningocele. Hydronephrosis (77% low grade) was found in 35/176 children and 18/71 adults. Hydronephrosis was associated with low estimated glomerular filtration rate in stepwise fashion, independent of kidney size and scarring. However, across cystatin C based pediatric equations, any hydronephrosis (compared to none) had 23%-48% sensitivity, and high grade hydronephrosis (compared to none or low grade) had 4%-15% sensitivity for estimated glomerular filtration rate <90 ml/min/1.73 m2, which remained unchanged after excluding small kidneys and scarring. Across cystatin C based adult equations, any and high grade hydronephrosis had 55%-75% and 40%-100% sensitivity, respectively, for estimated glomerular filtration rate <90 ml/min/1.73 m2, although with wide confidence intervals. Specificity was higher with high grade vs any hydronephrosis. Sensitivities were higher for estimated glomerular filtration rate <60 ml/min/1.73 m2. CONCLUSIONS Hydronephrosis was associated with low estimated glomerular filtration rate but had poor sensitivity for cystatin C based estimated glomerular filtration rate <90 ml/min/1.73 m2, especially among children with spina bifida.
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Affiliation(s)
- David I. Chu
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren C. Balmert
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Liqi Chen
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cameron Arkin
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Theresa Meyer
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Diana K. Bowen
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Kavita S. Hodgkins
- Division of Kidney Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Robin M. Bowman
- Division of Neurosurgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Earl Y. Cheng
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Elizabeth B. Yerkes
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Tamara Isakova
- Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Wang W, Fang H, Xie P, Cao Q, He L, Cai W. Create a predictive model for neurogenic bladder patients: upper urinary tract damage predictive nomogram. Int J Neurosci 2019; 129:1240-1246. [PMID: 31401918 DOI: 10.1080/00207454.2019.1655016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To create a nomogram to evaluate the risk of upper urinary tract damage (UUTD) in patients with neurogenic bladder (NGB) Methods: A retrospective analysis was conducted on 301 patients with NGB who were admitted to certain hospitals. Data collected included clinical symptoms, patients' characteristics, laboratory parameters, imaging findings, and urodynamic parameters. The least absolute shrinkage and selection operator(LASSO)regression model was used to optimise the selection of predictors. Multivariate logistic regression analysis was performed to develop a UUTD risk predictive model. Validation was performed by bootstrap. Results: The predictors included in the nomogram included sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence. The model presented good discrimination with a C-index value of 0.796 (95% confidence interval: 0.74896-0.84304) and good calibration. The C-index value of the interval validation was 0.7872112. The results of decision curve analysis (DCA) demonstrated that the UUTD-risk predictive nomogram was clinically useful. Conclusion: The nomogram incorporating the sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence could be an important tool of UUTD risk prediction in NGB patients.
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Affiliation(s)
- Wenqiang Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
| | - Hengying Fang
- Department of Nursing, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Peng Xie
- Department of Critical Care Medicine, Nanchong Central Hospital, the Second Clinical Medical College of North Sichuan Medical College , Nanchong , China
| | - Qunduo Cao
- Department of Urology, Peking University Shenzhen Hospital , Shenzhen , China
| | - Ling He
- Department of Radiation Oncology Department, Nanfang Hospital, Southern Medical University, Guangzhou , China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
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Musco S, Padilla-Fernández B, Del Popolo G, Bonifazi M, Blok BFM, Groen J, 't Hoen L, Pannek J, Bonzon J, Kessler TM, Schneider MP, Gross T, Karsenty G, Phé V, Hamid R, Ecclestone H, Castro-Diaz D. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review. Neurourol Urodyn 2018; 37:1522-1540. [PMID: 29392753 DOI: 10.1002/nau.23501] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/01/2017] [Indexed: 11/07/2022]
Abstract
AIM The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed in March 2017. Only neuro-urological patients assessed by urodynamics were included. Any outcome of upper urinary tract function were evaluated. RESULTS Forty-nine studies (1 randomized controlled trial, 9 prospective, and 39 retrospective case series) reported urodynamic data on 4930 neuro-urological patients. Of those, 2828 (98%) were spina bifida (SB) children. The total number of adults was 2044, mainly having spinal cord injury (SCI) (60%). A low bladder compliance was found in 568 (46.3%) and 341 (29.3%) of the paediatric and adult population, respectively. Hydronephrosis (HDN) was detected in 557 children (27.8%) in 19/28 studies and 178 adults (14.6%), mainly SCI, in 14/21 studies. Nine out of 30 multiple sclerosis (MS) patients affected by HDN (16.8%) showed low compliance in 4/14 studies. CONCLUSIONS Patients with SB and SCI have a higher risk of developing UUTD (mainly reported as HDN) compared to those with MS. Reduced compliance and high DLPP were major risk factors for UUTD. Although our findings clarify the mandatory role of urodynamics in the management of NLUTD, standardization and better implementation of assessments in daily practice may further improve outcomes of neuro-urological patients based on objective measurements, that is, urodynamics.
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Affiliation(s)
- Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Barbara Padilla-Fernández
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Matteo Bonifazi
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Jerome Bonzon
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Paris 6 University, Paris Cedex 13, France
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Hazel Ecclestone
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - David Castro-Diaz
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Zambon JP, Koslov DS, Mihai B, Badlani GH. Bladder and Ureteral Dysfunction Leading to Hydronephrosis and Hydroureteronephrosis in Adults. Urology 2017; 117:1-8. [PMID: 29287975 DOI: 10.1016/j.urology.2017.11.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
Chronic non-stone-related hydronephrosis from supravesical or bladder dysfunction in adults is often detected incidentally. This study aims to review the literature regarding supravesical obstruction or bladder dysfunction leading to bilateral hydronephrosis in adults and to develop an algorithm to identify patients at risk of renal failure. Cross-sectional studies, retrospective and prospective cohorts, clinical trials, and systematic reviews from 1980 to 2017 were included. From 8115 articles screened, 39 met the inclusion criteria. Despite the lack of studies addressing this issue, this review brings up a rational evidence-based algorithm to diagnose and manage adults with bilateral hydronephrosis due to supravesical or bladder disease or dysfunction.
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Affiliation(s)
- Joao P Zambon
- Department of Urology, Wake Forest University, Winston Salem, NC
| | - David S Koslov
- Department of Urology, Wake Forest University, Winston Salem, NC
| | - Bianca Mihai
- Department of Urology, Wake Forest University, Winston Salem, NC
| | - Gopal H Badlani
- Department of Urology, Wake Forest University, Winston Salem, NC.
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