BASIC FIBROBLAST GROWTH-FACTOR IN THE URINE OF CHILDREN WITH VOIDING PATHOLOGY

Purpose: Basic fibroblast growth factor is a mediator of tissue respon se to injury. Voiding pathology often results in bladder abnormalities . We prospectively determined whether basic fibroblast growth factor i s elevated in the urine of children with bladder dysfunction compared to that of normal controls. Materials and Methods: A total of 97 conse cutive children with myelomeningocele and 32 with voiding pathology du e to other etiologies underwent urodynamic testing, and 11 children wi th no bladder symptoms and sterile urine served as controls. Urinary b asic fibroblast growth factor levels were assayed by enzyme-linked imm unosorbent assay and normalized to urinary creatinine. Results: Mean u rinary basic fibroblast growth factor was higher in bladder dysfunctio n from myelomeningocele (6,673 pg./gm. creatinine, p = 0.0015) and oth er etiologies (5,665 pg./gm. creatinine, p = 0.0025) compared with uri ne from normal bladders (2,995 pg./gm. creatinine). In the myelomening ocele group urinary tract infection was associated with higher urinary basic fibroblast growth factor than in sterile urine (9,214 versus 5, 642 pg./gm. creatinine, p = 0.018). Patient age, gender, remote bladde r surgery, clean intermittent catheterization, detrusor hyperreflexia, detrusor compliance, age adjusted pressure specific bladder volume, l ow grade reflux and degree of trabeculation did not correlate with lev els of basic fibroblast growth factor (p >0.05). Conclusions: Urinary elevation of basic fibroblast growth factor, a critical mediator of wo und repair, in children with voiding pathology and clinically abnormal bladders supports the paradigm that bladder dysfunction may result fr om generalized response-to-injury mechanisms. The role of fibrogenic c ytokines, such as basic fibroblast growth factor, merits further direc ted investigation in bladder pathology.