Evaluation of urodynamic findings in children with neuropathic bladder

Objective: The approach to children with neuropathic bladder dysfunction (NBD) varies widely, ranging from proactive to reactive approaches on the spectrum. We aimed to determine which approach is more appropriate for preserving kidney function by retrospectively evaluating the findings of our patients who were managed proactively in the postnatal period in our clinic due to NBD, and comparing them with the findings of patients with a previous diagnosis who were followed with a reactive strategy. Materials and Methods: In our study, the files of NBD patients who applied to the Turgut Özal Medical Center Pediatric Urodynamics Unit between 2018 and 2022 were retrospectively examined. Patients who had been followed for at least 1 year with a diagnosis of NBD in our clinic, had urinary system ultrasonography (USG), voiding cystourethrography, dimercaptosuccinic acid (DMSA) scintigraphic evaluations, and urodynamic studies (UDS) were included in the study. A total of 180 patient files were reviewed, and a total of 143 patients (74 males and 69 females, aged 0-18) who met the study criteria were included. The patients were compared with each other in terms of demographic and clinical characteristics, including age groups (under 5 years and above), gender, and renal damage status. They were also compared regarding recurrent urinary tract infections (UTIs), vesicoureteral reflux (VUR), UDS findings, renal damage status, and rates of chronic kidney disease (CKD). Results: In our study, renal scarring was detected in 58 (40.6%) children with NBD and CKD was observed in 16 (11.2%) children based on DMSA scintigraphic evaluation. The UDS parameters that can affect the development of renal scarring were determined to be detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-voiding residue (p=0.044, p=0.014, and p=0.038, respectively). Additionally, it was determined that young age, timing of meningomyelocele surgery, history of recurrent symptomatic febrile UTIs, presence of hydronephrosis/bladder wall trabeculation on urinary system USG, and VUR were identified as other significant factors affecting the development of renal damage (p=0.023, p=0.0001, p=0.009, p=0.0001 and p=0.0001, respectively). vii Conclusion: We believe that a proactive approach, including clean intermittent catheterization and the use of anticholinergic medications, as well as UDS, can prevent both recurrent UTIs and secondary VUR in infants with NBD. This approach can also reduce the risk of kidney damage, CKD, and end-stage renal disease. Keywords: Child, Spinal dysraphisms, Neuropathic bladder, Urodynamics