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S22-9
(P)
AMBULATORY STATUS IS ASSOCIATED WITH LOWER URINARY TRACT
OUTCOMES IN CHILDREN WITH OPEN SPINAL DYSRAPHISM
Woo Jin KIM, Sayaka AKIYAMA and Yuichiro YAMAZAKI
Kanagawa Children's Medical Center, Urology, Yokohama, JAPAN
PURPOSE
Veenboer et al reported clinical determinants for lower urinary tract deterioration in adults with spinal dysraphism (SD)
(J Urol 2014; 192: 477-82). They concluded that being wheelchair bound (non-ambulatory) was a significant
determinant, whereas open SD and hydrocephalus were not. Whether this tendency is seen in pediatric cohorts was
investigated.
MATERIAL AND METHODS
Children with open SD, who underwent videourodynamics (VUDS) at the age of 5 to 18 years between 2005 and 2014,
were retrospectively investigated. High MDP (maximum detrusor pressure during filling or at leak 40 cm H
2
O or
greater), low bladder compliance (less than 10 ml/cm H
2
O), bladder trabeculation and VUR were defined as unfavorable
findings on VUDS. Logistic regression analysis was done in which 2 clinical determinants, i.e. mobility and having
ventriculoperitoneal shunt, were separately associated with each unfavorable finding on VUDS. Additionally, to
dichotomize patients as the prepubertal cohorts (under 12 years old) and the postpubertal cohorts (12 years of age and
older), analysis was done.
RESULTS
A total of 93 patients (41 males, 52 females; median age, 12.1 years) met the inclusion criteria. Patients with
wheelchair and ventriculoperitoneal shunt were 32 and 66, respectively. Being ambulatory was significantly associated
with bladder trabeculation and VUR in the postpubertal cohorts (p= 0.001, p= 0.001, respectively). Having
ventriculoperitoneal shunt was significantly associated with high MDP in the postpubertal cohorts (p= 0.008).
CONCLUSIONS
In contrast to the adult report, being wheelchair bound was not associated with lower urinary tract deterioration in
children with open SD. In pediatric cohorts, being ambulatory and having ventriculoperitoneal shunt were significant
determinants for lower urinary tract deterioration, especially after puberty.