Evaluation of the urinary tract in children with myelomeningocele

Pathogenic Mechanisms and Therapy Development for C9orf72 Amyotrophic Lateral Sclerosis/Frontotemporal Dementia

In 2011, a hexanucleotide repeat expansion in the first intron of the C9orf72 gene was identified as the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). The proposed disease mechanisms include loss of C9orf72 function and gain of toxicity from the bidirectionally transcribed repeat-containing RNAs. Over the last few years, substantial progress has been made to determine the contribution of loss and gain of function in disease pathogenesis. The extensive body of molecular, cellular, animal, and human neuropathological studies is conflicted, but the predominance of evidence favors gain of toxicity as the main pathogenic mechanism for C9orf72 repeat expansions. Alterations in several downstream cellular functions, such as nucleocytoplasmic transport and autophagy, are implicated. Exciting progress has also been made in therapy development targeting this mutation, such as by antisense oligonucleotide therapies targeting sense transcripts and small molecules targeting nucleocytoplasmic transport, and these are now in phase 1 clinical trials.

Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review

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.

The value of leak pressure and bladder compliance in the urodynamic evaluation of meningomyelocele patients

A total of 61 patients with myelodysplasia underwent water cystometry and electromyography of the external sphincter. Of these patients 27 underwent video fluorourodynamics as a part of preoperative evaluation or instead of a voiding cystometrogram. Renal quantitative scintillation camera studies detected 7 patients with mild upper tract deterioration, even when other tests failed to do so. A total of 31 patients had upper tract deterioration as detected by excretory urography, ultrasound and/or renal scan studies, and were designated as group 1, while 30 had normal upper tracts and were designated as group 2. Bladder compliance in group 1 was significantly lower than that in group 2 (4.5 versus 11.3 ml./cm. water, p = 0.001). Leak pressure in group 1 was significantly higher than in group 2 (42.3 versus 26.1 cm. water, p = 0.019). In summary, patients with evidence of upper tract deterioration had lower bladder compliance and higher leak pressure than patients with normal kidneys.