Login to Access Video or Poster Abstract: MP85-08
Sources of Funding: None

Introduction

Poorly compliant neurogenic bladders (NGB) with detrusor leak point pressures above 40 cm H2O (dLPP>40) have been associated with deterioration of renal function in children. As such, dLPP>40, despite clean intermittent catheterization (CIC) and anticholinergics, often mandates augmentation or diversion. While we recommend augmentation cystoplasty or diversion to appropriate patients, many elect for non-surgical management. Non-surgical management consists of rigorous urodynamic (UDS) and renal ultrasound (RUS) follow-up, paired with adjustments to CIC routine to keep bladder volumes below that volume at which dLPP>40, adjustments to anticholinergics, and intradetrusor botulinum toxin Type A (BTX). We describe the renal function outcomes of non-surgical management of adults with poorly compliant (dLPP>40) NGB.

Methods

We retrospectively reviewed the charts of all patients at our Gillette Lifetime adult congenital urology clinic undergoing UDS from January 2011 to June 2016. Patients with dLPP>40 who opted for non-surgical management were included; this study was noted as their &[Prime]index UDS&[Prime] for calculation of follow-up. The primary endpoint was deterioration of renal function as evidenced by change in chronic kidney disease (CKD) stage, progression to CKD-III, or new/worsening hydronephrosis.

Results

Of 210 patients who underwent UDS, 45 had dLPP>40. After exclusions for incomplete data (n=7) or augmentation cystoplasty (n=11), 27 were the subject of study. 15/27 (56%) were women and all 27 were Caucasian. Median age was 29 years (IQR 25, 35). 21 (78%) had NGB due to spina bifida. Median dLPP on index UDS was 47 cm H2O (IQR 42, 60). The most common interventions for dLPP>40 were adjustment to anticholinergics (n=17, 63%), modification of CIC schedule (n=14, 52%), and BTX (n=4, 15%). Last median follow-up was 1.2 years for repeat UDS, 2.5 years for glomerular filtration rate (GFR), and 2.4 years for RUS. There was a median 2.3 mL/min/1.73 m² decrease in GFR (IQR -17, 7.5). No patients advanced their CKD stage. Repeat UDS demonstrated dLPP>40 resolved in 16/27 (59%) patients. New, mild hydronephrosis was seen in 1 patient.

Conclusions

At interim follow up of 2.4 years, a carefully tailored non-surgical treatment protocol for patients with NGB and dLPP>40 is safe and effective in patients with rigorous follow-up. Selecting patients for augmentation cystoplasty requires a balanced assessment of a multitude of patient-specific factors.

Funding

None