RENAL DETERIORATION IN MYELODYSPLASTIC CHILDREN - URODYNAMIC EVALUATION AND CLINICAL CORRELATES

Purpose: We determined which factors portend a higher risk of renal de terioration in the myelodysplastic child, and evaluated the sensitivit y and predictive value. Materials and Methods: We retrospectively revi ewed the medical history, imaging studies and urodynamics of 90 childr en with spinal dysraphism. Median patient age at initial evaluation wa s 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to up per tract changes and the resolution of these changes. Results: Statis tically significant relationships were identified between the urodynam ic parameters of leak point pressure, compliance and detrusor-sphincte r dyssynergia, and renal deterioration but not with resolution of dete rioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence o f reflux and parenchymal loss. Conclusions: With knowledge of the inhe rent sensitivity, specificity and predictive value of urodynamic param eters, selective use of urodynamics will assist in identifying patient s at risk of renal deterioration. Female patients with reflux are at g reatest risk of parenchymal loss. We advocate early institution of int ermittent catheterization in patients identified as high risk for dete rioration by urodynamics.