Urodynamic characteristics of neurogenic bladder in newborns with myelomeningocele and refinement of the definition of bladder hostility: Findings from the UMPIRE multi-center study
Urodynamic characteristics of neurogenic bladder in newborns with myelomeningocele and refinement of the definition of bladder hostility: Findings from the UMPIRE multi-center study
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DOI：
10.1016/j.jpurol.2021.04.019
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发表时间：
2021-11-01
影响因子：
2
通讯作者：
Cheng, Earl Y.
中科院分区：
文献类型：
--
作者：
Tanaka, Stacy T.;Yerkes, Elizabeth B.;Cheng, Earl Y.
简介 患有脊髓脊膜膨出的婴儿有患神经源性膀胱功能障碍引起的慢性肾脏疾病的风险。尿动力学评估对于对个体肾功能恶化进行风险分层起着关键作用。目的 提出脊柱裂幼儿泌尿外科管理以保留初始肾功能 (UMPIRE) 方案的基线尿动力学结果，提出显示我们原始分类方案不足之处的过程，并提出膀胱敌意和分类的精确定义。研究设计 UMPIRE 方案对美国九家儿童医院的一组患有脊髓脊膜膨出的新生儿进行了跟踪研究。婴儿出生后不久就开始进行清洁间歇导尿。如果残余量低并且没有肾积水或有轻度肾积水，则停止导尿。在 3 个月龄或之前获得基线尿动力学以确定进一步的治疗。根据方案特定的定义，尿动力学研究由临床中心和中央审查小组进行审查；如有必要，由所有现场泌尿科医师达到100%一致。结果 我们回顾了 2015 年 5 月至 2017 年 9 月期间进行的 157 项新生儿尿动力学研究。在这 157 名婴儿中，54.8% 是男孩 (86/157)。 18.4% (29/157) 的新生儿在子宫内进行了脊髓脊膜膨出闭合术，81.5% (128/157) 的新生儿在出生后进行了脊髓脊膜膨出闭合术。初步审查后，审查人员就 50% (79/157) 的研究中的总体膀胱分类达成一致。最终一致率达到100%，解读进一步规范。我们发现，不可能可靠地区分婴儿由于逼尿肌过度活动导致的膀胱收缩和自主排尿收缩。我们修改了分类系统，将“正常”和“安全”类别归为“低风险”类别。此外，尿动力学研究的其他要素无法支持表面贴片电极对逼尿肌括约肌协同失调（DSD）的诊断。我们将 DSD 排除在修订后的高风险类别之外。最终分类为高风险，占 15% (23/157)；中等风险占 61% (96/157)； 24% (38/157) 的风险较低。结论 我们发现我们最初对膀胱敌意的分类存在缺陷。值得注意的是，DSD 无法通过电极表面贴片进行可靠测量。这种变化对未来肾脏结局的影响仍有待确定。
Introduction Infants with myelomeningocele are at risk for chronic kidney disease caused by neurogenic bladder dysfunction. Urodynamic evaluation plays a key role to risk stratify individuals for renal deterioration. Objective To present baseline urodynamic findings from the Urologic Management to Preserve Initial Renal function for young children with spina bifida (UMPIRE) protocol, to present the process that showed inadequacies of our original classification scheme, and to propose a refined definition of bladder hostility and categorization. Study design The UMPIRE protocol follows a cohort of newborns with myelomeningocele at nine children's hospitals in the United States. Infants are started on clean intermittent catheterization shortly after birth. If residual volumes are low and there is no or mild hydronephrosis, catheterization is discontinued. Baseline urodynamics are obtained at or before 3 months of age to determine further management. Based on protocol-specific definitions, urodynamic studies were reviewed by the clinical site in addition to a central review team; and if necessary, by all site urologists to achieve 100% concurrence. Results We reviewed 157 newborn urodynamic studies performed between May 2015 and September 2017. Of these 157 infants, 54.8% were boys (86/157). Myelomeningocele closure was performed in-utero in 18.4% (29/157) and postnatally in 81.5% (128/157) of newborns. After primary review, reviewers agreed on overall bladder categorization in 50% (79/157) of studies. Concurrence ultimately reached 100% with further standardization of interpretation. We found that it was not possible to reliably differentiate a bladder contraction due to detrusor overactivity from a volitional voiding contraction in an infant. We revised our categorization system to group the"normal" and "safe" categories together as "low risk". Addition-ally, diagnosis of detrusor sphincter dyssynergia (DSD) with surface patch electrodes could not be supported by other elements of the urodynamics study. We excluded DSD from our revised high risk category. The final categorizations were high risk in 15% (23/157); intermediate risk in 61% (96/157); and low risk in 24% (38/157). Conclusion We found pitfalls with our original categorization for bladder hos-tility. Notably, DSD could not be reliably measured with surface patch of electrodes. The effect of this change on future renal outcomes remains to be defined.