Traumatic pediatric spinal cord injury: long-term outcomes of lower urinary tract function

Abstract

Long-term urodynamic and urological outcomes were evaluated in pediatric patients following traumatic spinal cord injury (SCI). The medical charts of three pediatric patients following traumatic SCI were retrospectively reviewed. The level of the injury was cervical in two patients and thoracic in one. Two patients, whose initial urodynamics demonstrated voluntary or reflex detrusor contraction with synergic sphincter relaxation, managed to void; however, urinary management was switched in one of these patients from voiding to clean intermittent catheterization (CIC) with anti-cholinergic agents because of a treatment for urinary incontinence. There were also no episodes of hydronephrosis, vesicoureteral reflux (VUR) or renal dysfunction in these two patients. Although one patient with hyperreflexic bladder was initially managed with CIC and anti-cholinergic agents, detrusor myectomy was ultimately performed because of severe VUR associated with the progressive worsening of lower urinary tract (LUT) function. Careful follow-ups including urodynamics are mandatory for children with progressively deteriorated LUT function or problematic urinary incontinence.

Keywords: Paediatrics; Urinary tract.

Figure 1

Clinical course in patient (1). LUT function in this patient exhibited voluntary or reflex detrusor contraction with synergic sphincter relaxation in addition to DO. Urinary management was switched to self-voiding with anti-cholinergic agents. Voluntary self-voiding was possible with a good flow and less post-void residual urine. DO, detrusor overactivity; DSD, detrusor-sphincter dyssynergia; PVR, post-void residual urine volume; Qave, average flow rate; Qmax, maximum flow rate; PVR, post-void residual urine volume; UFM, uroflowmetry; V-UDS, video-urodynamics; VV, voided volume.

Figure 2

Clinical course in patient (3). Urodynamics in this patient revealed the deterioration of LUT function in spite of several conservative therapies during the follow-up period. BC, bladder capacity; DO, detrusor overactivity; DSD, detrusor-sphincter dyssynergia.

Figure 3

Video-urodynamics after detrusor myectomy 9 years after SCI in patient (3). V-UDS after detrusor myectomy showed good bladder compliance with a large bladder capacity and no evidence of DO or VUR. BC, bladder capacity; Cves, bladder compliance; DO, detrusor overactivity; Pabd, abdominal pressure; Pdet, detrusor pressure; Pves, vesical pressure; V-UDS, video-urodynamics; VUR, vesicoureteral reflux.