Yang Xinghuan,Chen Yan,Pu Qingsong,et al.Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder[J].Journal of Clinical Pediatric Surgery,,20():1005-1010.[doi:10.12260/lcxewkzz.2021.11.002]
Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder
- Keywords:
- Neurogenic Bladder; Upper Urinary Tract Injury; Risk Factors; Predictors; Child
- CLC:
- R726.945;R726.9
- Abstract:
- Objective To explore the risk factors and predictors of upper urinary tract injury in pediatric neurogenic bladder (PNB). Methods Between 2013 and 2020, retrospective analysis was performed for clinical history, laboratory tests, imaging examinations and urodynamic results of 131 PNB children. No specific treatment was offered before hospitalization. They were divided into two groups of upper urinary tract injury and non-injury. The parameters of renal function and the results of imaging examination of urinary system were recorded. Multivariate Logistic stepwise regression analysis was employed for determining the risk factors of upper urinary tract injury. And receiver operating characteristic (ROC) curve was plotted for examining the clinical predictors of upper urinary tract injury. Results There were 82 children with impaired urinary tract ((7.08±3.79) years, 37 boys/45 girls) and 49 with unimpaired urinary tract ((8.03±4.06) years, 27 boys/22 girls). Bladder volume ratio (BVR), maximum detrusor pressure during filling (maxPdet), compliance (△C), maximum flow rate (Qmax), bladder emptying efficiency (BVE), detrusor leak point pressure (DLPP), bladder wall thickness (BWT), uroleucocyte, lymphocyte ratio, neutrophilratio, lymphocyte count (LY) and the incidence of overactive bladder (OAB), detrusor sphincter dyssynergia (DSD), acontractile detrusor (ACD), "christmas-tree-shaped" bladder, bladder wall roughness, multiple diverticuliform changes, vesicoureteric reflux (VUR) and positive urinary culture were significantly different between two groups (P<0.05). Multivariate Logistic stepwise regression analysis revealed that elevated DLPP (OR:1.223, 95%CI:1.035-1.444), thickened BWT (OR:3.763, 95%CI:1.347-10.551), lowered △C(OR:0.760, 95%CI:0.603-0.957) and lymphocytopenia (OR:0.507, 95%CI:0.274-0.940) were risk factors. ROC curve revealed that BWT was an even better risk predictor of upper urinary tract injury (AUC=0.866, 95%CI:0.800-0.933). The optimal cut-off value was 3.925 mm (sensitivity 0.854, specificity 0.776). Conclusion Elevated DLPP, lowered △C, thickened BWT and reduced LY are risk factors for upper urinary tract injury. BWT has great values in predicting upper urinary tract injury in PNB. And BWT>3.925 mm may be adopted as a predictive critical value.
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Memo
收稿日期:2021-09-28。
基金项目:国家自然科学基金委员会联合基金项目（编号：U1904208）；河南省医学科技攻关计划省部共建项目（编号：SBGJ2018059）
通讯作者:文建国,Email:wenjg@hotmail.com