Abstract:

Purpose: It was aimed to evaluate the frequency of kidney damage and possible risk factors by retrospectively evaluating the urinary system findings of pediatric patients followed up for 'spinal dysraphism' in Pamukkale University Pediatric Nephrology Clinic. Materials and methods: The data of pediatric patients who were followed up with the diagnosis of neurogenic bladder due to spinal dysraphism between January 2014 and August 2021 were evaluated retrospectively. Demographic and clinical characteristics of the patients, whether they received clean intermittent catheter (CIC) treatment, if so, when to start and at the last follow-up, urinary system ultrasound findings (hydronephrosis and bladder wall thickness), presence of vesicoureteral reflux (VUR), dimercaptosuccinic acid scintigraphy findings, according to Shwartz Glomerular filtration rate (eGFR) levels were recorded. Results: A total of 44 patients, 17 male and 27 female, were included in the study. The mean age was 7.2±4.2 years. Twenty (45.5%) of the children were followed for more than 5 years. Among the cases, meningomyelocele (88.6%) was found to be the most common defect. There were only 2 patients who did not undergo surgery for spinal dysraphism. Approximately 90% of the cases were operated before 1 year of age. Approximately 40% of the patients were found to have kidney damage on DMSA scintigraphy, 52% had hydronephrosis, and approximately 16% had low eGFR. In urodynamic findings, 18 (40.9%) patients had high pressure bladder (bladder pressure >40 cmH2O), 11 (25%) patients had areflex bladder, 13 (29.5%) patients had normal urodynamic findings. Fifteen (34.1%) patients had VUR. There was no significant relationship between operation time, age at onset of CIC, tethered cord development and kidney damage. Conclusion: The main goal in the management of urological problems in patients with spinal dysraphism is the protection of the upper urinary tract. Although there are suggestions for early diagnosis and treatment of urological problems in these patients, the management of these patients is still controversial and difficult.

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