신경인성 방광 환아에서 상부요로계 손상의 위험 인자 분석
Risk Factors for Upper Urinary Tract Deterioration in Children with Neurogenic Bladder
권택민, 김건석, 한지연, 박준수, 박명찬,
소속 상세정보
권택민 ( Kwon Taek-Min )
울산대학교 의과대학 비뇨기과학교실
김건석 ( Kim Kun-Suk )
울산대학교 의과대학 비뇨기과학교실
한지연 ( Han Ji-Yeon )
울산대학교 의과대학 비뇨기과학교실
박준수 ( Park Jun-Soo )
울산대학교 의과대학 비뇨기과학교실
박명찬 ( Park Myung-Chan )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320090500121248
Abstract
Purpose: We evaluated the risk factors for upper urinary tract deterioration in children with neurogenic bladder.
Materials and Methods: The study population consisted of 60 children (36 boys, 24 girls) with neurogenic bladder confirmed by urodynamic study between January 1994 and June 2007. The average follow-up period was 48 months. The patients’ medical records were assessed concerning gender, presence of vesicoureteral reflux (VUR), hydronephrosis, type of spinal dysraphism, level of spinal dysraphism, practice of clean intermittent catheterization (CIC), type of neurogenic bladder, bladder capacity, compliance, detrusor sphincter dyssynergia, recurrent urinary tract infection (UTI), and timing of primary neurosurgical repair. Upper urinary tract deterioration was diagnosed by 99m technetium-dimercaptosuccinic acid renal scan (DMSA) and aggravation of hydronephrosis and VUR.
Results: Upper urinary tract deterioration was detected in 15 patients (25%). Hydronephrosis, VUR, and UTI were associated with upper urinary tract deterioration in the univariate analyses. In the multivariate analyses, hydronephrosis [odds ratio (OR)=2.181, 95% confidence interval (CI)= 1.191-11.941, p=0.036] and recurrent UTI [OR=5.810, 95% CI=1.200-28.192, p=0.029] were independent risk factors for upper urinary tract deterioration.
Conclusions: Hydronephrosis and recurrent UTI increase the risk of upper urinary tract deterioration in children and adolescents with neurogenic bladder. Therefore, intensive observation and prompt intervention may be recommended for such cases.
키워드
Neurogenic bladder;Urinary tract;Risk factors
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