1
|
Chua ME, Yadav P, Wang PZT, Mau EE, Keefe DT, De los Reyes TJ, Lee L, Blais AS, Lorenzo AJ. 2023 Canadian Urological Association/Pediatric Urologists of Canada guideline: Pediatric patients with neurogenic lower urinary tract dysfunction Full-text version. Can Urol Assoc J 2023; 17:E338-E357. [PMID: 37851907 PMCID: PMC10581733 DOI: 10.5489/cuaj.8390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Michael E. Chua
- Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Priyank Yadav
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Zhan Tao Wang
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Elke E. Mau
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel T. Keefe
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Thomas J. De los Reyes
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Lee
- Division of Urology, Department of Surgery, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Armando J. Lorenzo
- Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
2
|
Ferreira RVB, Pinheiro HCG, de Oliveira Melo F, Gama GL, Monteiro LMC, Fontes JM, de Oliveira Cruz GN, de Araújo GF, Amorim MMR, Melo A. Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil. Trop Med Int Health 2022; 27:583-591. [PMID: 35441418 DOI: 10.1111/tmi.13754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. METHODS This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. RESULTS Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. CONCLUSIONS UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.
Collapse
Affiliation(s)
| | | | | | - Gabriela Lopes Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
| | | | | | | | | | | | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
| |
Collapse
|
3
|
Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatr Nephrol 2022; 37:959-972. [PMID: 33839937 DOI: 10.1007/s00467-021-05059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nearly 50% of the world population and 60% of children aged 0 to 14 years live in low- or lower-middle-income countries. Paediatric nephrology (PN) in these countries is not a priority for allocation of limited health resources. This article explores advancements made and persisting limitations in providing optimal PN services to children in such under-resourced areas (URA). METHODS Medline, PubMed and Google Scholar online databases were searched for articles pertaining to PN disease epidemiology, outcome, availability of services and infrastructure in URA. The ISN and IPNA offices were contacted for data, and two online questionnaire surveys of IPNA membership performed. Regional IPNA members were contacted for further detailed information. RESULTS There is a scarcity of published data from URA; where available, prevalence of PN diseases, managements and outcomes are often reported to be different from high income regions. Deficiencies in human resources, fluoroscopy, nuclear imaging, immunofluorescence, electron microscopy and genetic studies were identified. Several drugs and maintenance kidney replacement therapy are inaccessible to the majority of patients. Despite these issues, regional efforts with support from international bodies have led to significant advances in PN services and infrastructure in many URA. CONCLUSIONS Equitable distribution and affordability of PN services remain major challenges in URA. The drive towards acquisition of regional data, advocacy to local government and non-government agencies and partnership with international support bodies needs to be continued. The aim is to optimise and achieve global parity in PN training, investigations and treatments, initially focusing on preventable and reversible conditions.
Collapse
Affiliation(s)
| | | | - Sampson Antwi
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | |
Collapse
|
4
|
Sager C, Burek C, Gomez YR, Weller S, Ruiz J, Imizcoz FL, Szklarz T, Rosiere N, Monteverde M, Campmany L, Vazquez JA, De Castro F, Bernardez L, Adragna M, Corbetta JP. Nephro-urological outcomes of a proactive management of children with spina bifida in their first 5 Years of life. J Pediatr Urol 2022; 18:181.e1-181.e7. [PMID: 34991991 DOI: 10.1016/j.jpurol.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. MATERIAL AND METHODS This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. RESULTS Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. DISCUSSION Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. CONCLUSIONS Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.
Collapse
Affiliation(s)
- Cristian Sager
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina; Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
| | - Carol Burek
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina; Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Yesica Ruth Gomez
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina; Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Santiago Weller
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Javier Ruiz
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Felicitas Lopez Imizcoz
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Tatiana Szklarz
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Nicolas Rosiere
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Marta Monteverde
- Nephrology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Liliana Campmany
- Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Jorge Agrimbau Vazquez
- Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Fernanda De Castro
- Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Lorena Bernardez
- Pediatrics Department, Interdisciplinary Group Myelomeningocele, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Marta Adragna
- Nephrology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| |
Collapse
|
5
|
Cruz GN, Monteiro AC, Gomes Junior SC, Fontes JM, Saad T, Costa Monteiro LM. Virus-related neurological lower urinary tract dysfunction: Lessons learned during 4-year follow-up of patients with Congenital Zika Syndrome. J Pediatr Urol 2021; 17:523.e1-523.e9. [PMID: 33934997 PMCID: PMC10105604 DOI: 10.1016/j.jpurol.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment. OBJECTIVE To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies. METHODOLOGY A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzed using the IBM SPSS 22 software. RESULTS From the cohort of 90 patients, 56 completed the second urodynamic assessment and were included. One presented underactive bladder and 55 overactive bladder. Among these 55, 39 were adherent and 16 non-adherents to the prescribed treatment. Among the 39 adherents, 8 adhered regularly to oxybutynin and clean intermittent catheterization (CIC), 29 to oxybutynin alone, and two to catheterization alone. During follow-up, the number of patients with urinary tract infection and postvoid residual increased, but all other parameters had improved. Renal and bladder ultrasonography improved in 10, maximum bladder pressure decreased in 22 and maximum cystometric capacity and compliance increased in 14 patients. Sixteen patients did not adhere regularly to the prescribed treatment and although the number of patients with urinary tract infection reduced with antibiotic therapy, their bladder capacity and compliance did not improve during follow-up. DISCUSSION Ultrasonographic and urodynamic improvements were observed after 10.8 ± 7.5 months of treatment, including one patient with ureterohydronephrosis that resolved. Adherence to CIC remains a challenge and reflected in the number of patients presenting urinary tract infection and postvoid residual. The immediate clinical relevance is the major study strength, given the previously uncharacterized therapy options for this patient population. The number of patients remains one of the study limitations, reducing our ability to perform more advanced statistical analyses. CONCLUSION Patients with Zika-related neurological lower urinary tract dysfunction may benefit from conventional therapies. Results confirmed ultrasonographic and urodynamic improvements after treatment, although not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.
Collapse
Affiliation(s)
- G N Cruz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | | | - S C Gomes Junior
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - Juliana M Fontes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - T Saad
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - L M Costa Monteiro
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
6
|
Wong-You-Cheong JJ, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Goldfarb S, Gore JL, Gupta RT, Heilbrun ME, Lyshchik A, Metter DF, Purysko AS, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Lockhart ME. ACR Appropriateness Criteria® Renal Failure. J Am Coll Radiol 2021; 18:S174-S188. [PMID: 33958111 DOI: 10.1016/j.jacr.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging. The main role of imaging is to detect treatable causes of renal failure such as ureteral obstruction or renovascular disease and to evaluate renal size and morphology. Ultrasound is the modality of choice for initial imaging, with duplex Doppler reserved for suspected renal artery stenosis or thrombosis. CT and MRI may be appropriate, particularly for urinary tract obstruction. However, the use of iodinated and gadolinium-based contrast should be evaluated critically depending on specific patient factors and cost-benefit ratio. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Jade J Wong-You-Cheong
- University of Maryland School of Medicine, Baltimore, Maryland, Vice Chair, Quality and Safety, Diagnostic Radiology, University of Maryland Medical Center.
| | | | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington, American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina, Chair, Meetings Sub-Committee, ACR, Member, Commission on Publications and Lifelong Learning
| | | | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, Deputy Editor, Journal of Ultrasound in Medicine
| | - Darlene F Metter
- UT Health San Antonio, San Antonio, Texas, Past-President and Alternate Councilor, Texas Radiological Society, Chair, IT Health San Antonio Radioactive Drug and Research Committee, Chair, Nuclear Regulatory Commission Advisory Committee on the Medical Uses of Isotopes, Vice-Speaker, Society of Nuclear Medicine and Molecular Imaging House of Delegates, Member, Texas Department of State Health Services Texas Radiation Advisory Board
| | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina, American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Darcy J Wolfman
- Johns Hopkins University School of Medicine, Washington, District of Columbia
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama, Chair, ACR Appropriateness Committee
| |
Collapse
|
7
|
Costa Monteiro LM, Cruz GNO, Monteiro AC, Moreira MEL. Comment on the 'Letter to the Editor' related to the article 'Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists'. J Pediatr Urol 2019; 15:434-435. [PMID: 31351948 DOI: 10.1016/j.jpurol.2019.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L M Costa Monteiro
- Instituto Nacional de Saúde da Mulher, da Criança e do, Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil.
| | - G N O Cruz
- Instituto Nacional de Saúde da Mulher, da Criança e do, Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| | | | - M E L Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do, Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| |
Collapse
|
8
|
Bagińska JO, Liszewska A, Wasilewska A, Korzeniecka-Kozerska A. The role of appetite-regulating hormones: Ghrelin and leptin in the nutritional status of children with neurogenic bladder due to myelomeningocele. J Paediatr Child Health 2019; 55:928-931. [PMID: 30488610 DOI: 10.1111/jpc.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/14/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Abstract
AIM We wanted to investigate serum levels of ghrelin and leptin - appetite-regulating hormones - and their correlation with the nutritional status of children with neurogenic bladder (NB) due to myelomeningocele (MMC) in comparison to healthy individuals. METHODS This prospective analysis was conducted on 67 children with NB after MMC and 20 healthy children. Children's medical charts were analysed to determine age, gender, anthropometric measurements, body mass index (BMI), activity assessment using Hoffer's scale and renal function parameters. Serum total ghrelin and leptin levels were measured using the enzyme-linked immunosorbent assay. RESULTS There were no differences in the age, gender, weight and BMI between the studied groups. Median serum levels of ghrelin and leptin were higher compared with the reference group. A significant negative correlation between serum leptin concentration and Hoffer's scale was found in children with NB. CONCLUSIONS Elevated levels of leptin and ghrelin could be considered factors influencing nutritional status in children with NB due to MMC. Children with NB after MMC may have disturbed endocrine regulation of energy homeostasis. Physical activity may be the factor that affects serum leptin concentration.
Collapse
Affiliation(s)
- Joanna O Bagińska
- Department of Pediatric Nephrology, Medical University of Białystok, Białystok, Poland
| | - Alicja Liszewska
- Department of Pediatric Nephrology, Medical University of Białystok, Białystok, Poland
| | - Anna Wasilewska
- Department of Pediatric Nephrology, Medical University of Białystok, Białystok, Poland
| | | |
Collapse
|
9
|
Costa Monteiro LM, Cruz GNDO, Fontes JM, Saad Salles TRD, Boechat MCB, Monteiro AC, Moreira MEL. Neurogenic bladder findings in patients with Congenital Zika Syndrome: A novel condition. PLoS One 2018; 13:e0193514. [PMID: 29494684 PMCID: PMC5832242 DOI: 10.1371/journal.pone.0193514] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Congenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract. As such, this descriptive case series has aimed to investigate whether CZS is linked with neurogenic bladder. Identifying such an association is paramount in the effort to recognize CZS complications that have putative treatment options that could mitigate the impact of CZS in infected children. METHODS Following IRB approval, urological assessment was performed in all patients referred to our clinic between June 2016 and May 2017 who presented with confirmed CZS-associated microcephaly. The research protocol consisted of obtaining clinical history, laboratory tests, lower and upper urinary tract ultrasounds, as well as a diagnostic urodynamic evaluation. ZIKA virus infection was previously confirmed by maternal history and positive PCR in babies and mothers. Microcephaly and other central nervous system abnormalities were established based on neurological assessment and associated imaging of the central nervous system (CT head and/or Brain MRI). RESULTS Twenty-two consecutive CZS patients were tested and confirmed to have neurogenic bladder. Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. Clinically significant increases in postvoid residual (PVR) were confirmed in 40% of cases while a urinary tract infection (UTI) was identified in 23% of cases. CONCLUSION Neurogenic bladder, a known treatable health condition, was confirmed in 100% of patients tested in this study, most presenting with high-risk urodynamic patterns known to lead to renal damage when left untreated. Follow up studies are necessary to provide further insight onto long-term disease progression and to investigate the response to standard therapies for neurogenic bladder. Nonetheless, we emphasize the importance of proactive management of neurogenic bladder and prompt referral so as to help mitigate CZS disease burden for patients and their families.
Collapse
Affiliation(s)
- Lucia Maria Costa Monteiro
- Department of Pediatric Urodynamics and Dysfunctional Voiding, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Glaura Nisya de Oliveira Cruz
- Department of Pediatric Urodynamics and Dysfunctional Voiding, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Marin Fontes
- Department of Pediatric Urodynamics and Dysfunctional Voiding, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tania Regina Dias Saad Salles
- Department of Pediatric Neurology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Cristina Bastos Boechat
- Department of Pediatric Radiology and Imagining, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Monteiro
- Department of Internal Medicine, University of California Los Angeles, (U.C.L.A), Los Angeles, California, United States of America
| | - Maria Elizabeth Lopes Moreira
- Department of Neonatology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
10
|
Rodríguez-Ruiz M, Somoza I, Curros-Mata N. Study of kidney damage in paediatric patients with neurogenic bladder and its relationship with the pattern of bladder function and treatment received. Actas Urol Esp 2016; 40:37-42. [PMID: 26183019 DOI: 10.1016/j.acuro.2015.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Kidney failure is the main cause of morbidity and mortality in patients with myelodysplasia. We analysed the presence of renal lesions in these patients using dimercaptosuccinic acid scintigraphy and related their presence with the type of vesical function and the delay in receiving appropriate management. MATERIAL AND METHODS We performed a retrospective study of patients with myelodysplasia treated in our hospital since 2004. We analysed the epidemiological and clinical data and the pattern of bladder function according to urodynamic studies. We classified the patients into 4 urodynamic patterns according to detrusor and sphincter behaviour. We linked this behaviour to renal function in the scintigraphy and the care received since birth. RESULTS The study included 39 patients with myelodysplasia. The most common bladder pattern was type A (61.5%), with sphincter and detrusor hyperactivity, followed by type D (20.5%), C (7.8%) and B (5.1%). Some 38% of our patients (n=15) had some type of nephropathy. Some 92.9% of the children who were properly treated during the first year of their life had no renal lesions in the scintigraphy. We found some type of nephropathy in 56% of the patients for whom appropriate treatment was delayed for more than a year. The nephropathy was more severe the later the management was started. CONCLUSIONS There is a statistically significant relationship between a delay in treatment and impairment in renal scintigraphy in patients with neurogenic bladders. The early study and treatment of patients is essential for decreasing renal impairment, reducing the need for surgery and improving the continence options.
Collapse
Affiliation(s)
- M Rodríguez-Ruiz
- Servicio de Cirugía Pediátrica, Complexo Hospitalario Universitario de A Coruña, La Coruña, España.
| | - I Somoza
- Servicio de Cirugía Pediátrica, Complexo Hospitalario Universitario de A Coruña, La Coruña, España
| | - N Curros-Mata
- Servicio de Cirugía Pediátrica, Complexo Hospitalario Universitario de A Coruña, La Coruña, España
| |
Collapse
|
11
|
Clinical characteristics of patients with neurogenic bladder due to myelomeningocele – Eighteen-year retrospective study; University Children's Hospital, Bialystok, Poland. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.pepo.2015.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
12
|
Korzeniecka-Kozerska A, Porowski T, Bagińska J, Wasilewska A. Urodynamic Findings and Renal Function in Children with Neurogenic Bladder after Myelomeningocele. Urol Int 2015; 95:146-52. [PMID: 26067248 DOI: 10.1159/000431184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Myelomeningocele (MMC) is a congenital central nervous system malformation caused by a failure of the neurulation process in early pregnancy. Patients with MMC present many abnormalities and the nervous, skeletal and urinary systems are the most affected. The aim of this study was to clinically evaluate patients with MMC, estimate renal and lower urinary tract (LUT) function and to ascertain whether urodynamic findings can predict the deterioration of urinary tract function. MATERIALS AND METHODS Medical records of 112 patients were gathered from a database and evaluated retrospectively. The data included age, sex, BMI Z-score WHO, physical activity, urodynamic parameters and diagnosis and renal function. RESULTS A total of 112 patients with MMC were enrolled in the study. There were no differences in age, sex, BMI Z-score WHO, physical activity, renal function and urodynamic findings (apart from cystometric capacity) between boys and girls. Detrusor overactivity was the most frequent urodynamic diagnosis in all groups of physical activity, level of lesion and in catheterized and non-catheterized children. The correlations between urodynamic findings and renal function tests were found. CONCLUSIONS Patients with neurogenic bladder after MMC most often present detrusor overactivity. LUT function is disturbed in all MMC patients independent of lesion level and physical activity.
Collapse
|
13
|
Lopes M, Ferraro A, Koch VH. Health-related quality of life of children and adolescents with CKD stages 4-5 and their caregivers. Pediatr Nephrol 2014; 29:1239-47. [PMID: 24577804 DOI: 10.1007/s00467-014-2769-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 12/28/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal replacement therapies may affect the quality of life of patients and their primary caregivers (PC). METHODS This study describes the perception of health-related quality of life (HRQoL) of children/adolescents with CKD stages 4-5, as well as of their PC (n = 64), in comparison to healthy peers and their PC (n = 129), respectively, based on the Peds QL™ 4.0 and Short Form-36 (SF-36) questionnaires and selected biomarkers. RESULTS Patients reported a deleterious impact on physical capacity and on social and school activities. A negative influence on emotional aspects was reported by older patients, but not by their PC. Hemodialysis, followed by peritoneal dialysis, had a more negative impact on patients' physical functioning domain. PC HRQol proxy reports differed from those of their children, especially in older patients. PC of both groups presented similar SF-36 scores. An association was demonstrated between the magnitude of treatment target inadequacies, lower specific dominion scores in the patients/PC proxy reports and PC SF-36 general health scores. CONCLUSION The HRQoL of patients with CKD stages 4-5 is negatively affected to different degrees depending on age and treatment modality. The results suggest an association between worsening HRQoL parameters and inadequate control of recognized therapeutic CKD treatment targets.
Collapse
Affiliation(s)
- Marcos Lopes
- Department of Pediatrics, Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas of the University of Sao Paulo Medical School, Rua das Mangabeiras 91/81, 01233-010, São Paulo, Brazil
| | | | | |
Collapse
|
14
|
Rocha-e-Silva M. Molecular and genetic aspects of oncology and infectology in Clinics. Clinics (Sao Paulo) 2012; 67:1353-6. [PMID: 23295585 PMCID: PMC3521794 DOI: 10.6061/clinics/2012(12)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
15
|
Rocha e Silva M. Pediatrics in Clinics: highlights. Clinics (Sao Paulo) 2012; 67:859-64. [PMID: 22948450 PMCID: PMC3416888 DOI: 10.6061/clinics/2012(08)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|