THE ROLE OF ANTIBIOTIC PROPHYLAXIS IN SPINA BIFIDA CHILDREN WITH VESICOURETERAL REFLUX

THE ROLE OF ANTIBIOTIC PROPHYLAXIS IN SPINA BIFIDA CHILDREN WITH VESICOURETERAL REFLUX

THE JOURNAL OF UROLOGY® 312 Vol. 181, No. 4, Supplement, Monday, April 27, 2009 875 THE ROLE OF ANTIBIOTIC PROPHYLAXIS IN SPINA BIFIDA CHILDREN WIT...

97KB Sizes 2 Downloads 40 Views

THE JOURNAL OF UROLOGY®

312

Vol. 181, No. 4, Supplement, Monday, April 27, 2009

875 THE ROLE OF ANTIBIOTIC PROPHYLAXIS IN SPINA BIFIDA CHILDREN WITH VESICOURETERAL REFLUX Daisuke Matsuno*, Morihiro Nishi, Yoshiyuki Shiroyanagi, Yuichiro Yamazaki, Yokohama, Kanagawa, Japan

Source of Funding: None

874 Is 40 cm H2O detrusor leak point pressure (DLPP) cut-off really reliable for upper urinary tract (UUT) protection in children with myelodysplasia? Tufan Tarcan, Istanbul, Turkey; Ilker Tinay*, Istanbul, Turkey; Cagri A Sekerci, Harika Alpay, Ferruh SimSek, Istanbul, Turkey INTRODUCTION AND OBJECTIVE: High DLPP is a risk factor for UUT in children with myelodysplasia, where 40 cm H2O is generally considered as the safe limit after McGuire’s study. The purpose of this study is to find out the most accurate cut-off level for the DLPP in terms of UUT protection in children with myelodysplasia. METHODS: We retrospectively reviewed 618 children with myelodysplasia followed at our multidisciplinary clinic between 1996 and 2008. Among these patients, 150 were included in the study based on the availability of urological follow-up data at age of 3 years. Children were assigned to 1 of 2 groups - those who had UUT deterioration at age 3 (group 1), which means hydronephrosis, VUR or scar on DMSA, or not (group 2). We compared the incidence of febrile urinary tract infections (FUTI), timing of the primary neurosurgical repair, secondary tethering of the spinal cord (STSC) at age 3 years and urodynamic findings between the groups. RESULTS: Conservative treatment rates are shown in table 1 and urodynamic findings in table 2. Urological follow-up data at age 3 years revealed higher incidences of FUTI and STSC in children in group 1. Different cut-off values of DLPP showed that DLPP above 20 cm H2O has a higher sensitivity for UUT deterioration (table 3). CONCLUSIONS: Determining the cut-off value of the DLPP as 20 cm H2O instead of 40 cm H2O showed a higher sensitivity to predict the risk group for UUT deterioration. Children with myelodysplasia, who have a DLPP between 20 and 40 cm H2O, should be followed closer since % 38.4 of these children in this study had UUT deterioration at age of 3. Table 1: Conservative treatment rates according to groups Group 1 Group 2 34 / 48 25 / 102 CIC (70.8 %) (24.5 %) 44 / 48 90 / 102 Anticholinergic treatment (91.6 %) (88.2 %) 44 / 48 72 / 102 Antibiotic prophylaxis (91.6 %) (70.6 %)

p value 0.001 0.651 0.023

Urodynamic findings according to groups Group 1

Group 2

Mean cystometric capacity (ml)

124.32

141.12

p value 0.18

Median DLPP (cm H2O)

48

29

0.021

UUT involvement according different DLPP cut-off values DLPP

Percentage of patients with upper tract involvement

Sensitivity (ROC analysis)

> 40 cm H2O > 30 cm H2O > 20 cm H2O

18 / 64 (28.12 %) 24 / 88 (27.27 %) 33 / 102 (32.35 %)

51.4 % 68.6 % 91.4 %

Source of Funding: None

INTRODUCTION AND OBJECTIVE: Last year at this meeting, we reported that a history of vesicoureteral reflux (VUR) was only associated with abnormal renal scan in children with spina bifida. However, the role of antibiotic prophylaxis in spina bifida children with VUR has not been discussed sufficiently. Regardless of antibiotic prophylaxis, bacteriuria is frequently observed in children with spina bifida who are on the clean intermittent catheterization (CIC) programs. Therefore, it is hard to decide whether antibiotic prophylaxis is effective in preventing recurrent febrile urinary tract infections and acute pyelonephritis. The aim of this study is to assess the effectiveness of the antibiotic prophylaxis in preventing renal scaring evaluated by DMSA renal scan in spina bifida children with VUR. METHODS: We studied 51 spina bifida children (20 boys and 31 girls) with VUR who had undergone DMSA renal scan. Mean age at the diagnosis of VUR was 4.1 +/- 4.4 years old (range 0.20 ~ 15.3) and mean age at DMSA scan was 11.9 +/- 6.0 years old (range 0.89 ~ 21.5). Mean follow-up period was 7.80 +/- 6.13 years. All of them had been managed with CIC programs. The decision of antibiotic prophylaxis after diagnosis of VUR was left to physician’s preference. Patients were divided into two groups with or without antibiotic prophylaxis, and the results of DMSA renal scan were compared between these two groups. DMSA renal scan was defined as abnormal if focal or multifocal perfusion defects were identified or if there was a split renal uptake of less than 40%. RESULTS: Twenty-nine (56.9%) of 51 children had been managed with the antibiotic prophylaxis. Twelve (41.4%) of these 29 children had an abnormal DMSA renal scan. On the other hand, 7 (31.8%) of 22 children without the antibiotic prophylaxis had abnormal DMSA findings. There was no significant difference between prophylactic and non-prophylactic group (p=0.57, Fisher’s exact probability test). CONCLUSIONS: The antibiotic prophylaxis didn’t have efficacy for preventing renal scarring in spina bifida children with VUR. Source of Funding: None

876 FOLLOW-UP OUTCOME OF PEDIATRIC MYELODYSPLASIA PATIENTS WITH MICTURITION FELEX WITHOUT URETHRAL SPHINCTER DYSSYNERGIA IN INITIAL VIDEOURODYNAMICS Takahiko Mitsui*, Hiroshi Tanaka, Kimihiko Moriya, Mayuko Matsuda, Katsuya Nonomura, Sapporo, Japan INTRODUCTION AND OBJECTIVE: Although the majority of children with myelodysplasia have urological abnormalities, the subset of children with myelodysplasia has normal lower urinary tract function in urodynamic studies. We retrospectively analyzed outcomes of followup in pediatric patients with myelodysplasia who had micturition reflex without urethral sphincter dyssynergia in videourodynamics (VUDS) at initial evaluation and were managed with spontaneous voiding. METHODS: A total of 20 children with myelodysplasia (14 boys and 6 girls), who were confirmed to have micturition reflex without dyssynergia of the detrusor and urethral sphincter in VUDS at initial evaluation, were enrolled in the study; mean age at the first presentation: 2.0 years, mean follow-up period: 4.8 years. These patients were reevaluated during follow-up using VUDS, uroflowmetry, ultrasonography, urinalysis and urine culture. RESULTS: Maximal detrusor pressure during voiding were <60cmH2O in 12 children, 60-89 cmH2O in 6 and q90cmH2O in 2. Anticholinergic agents and alpha 1-aderenergic blockers were used in 2 children each. Urinary tract management was switched from spontaneous voiding to clean intermittent catheterization in 4 children (20%) during follow-up, because deterioration of bladder deformity and vesicoureteral reflux occurred in 2 (at age 2 and age 5) and detrusor contractility was decreased to produce deterioration of voiding efficiency in 2 (at age 2 and age 12). Decreased detrusor contractility was implicated in spinal