Abstract General Information

Title

CAN WE PROSPECTIVELY FOLLOW NEUROGENIC BLADDER PATIENTS FROM THE FIRST YEAR? AN UNIFORM PROTOCOL WITH THE SAME TEAM AND URODYNAMIC DEVICE.

Introduction and objective

We have reviewed patients followed prospectively since 2018 in our Institution from the first year of age. Treatment is recommended according to the Leal da Cruz categorization system (J Urol. 2015).

Method

We looked at all urodynamic evaluation performed in our pediatric urology clinic associated with a clinical appointment from 2018 to 2023 and selected patients aged < 1 year at first urodynamic evaluation for retrospective analysis of data prospectively completed from our electronic charts. We evaluated diagnosis, age at first visit, clinical data, prevalence of hydronephrosis and vesicoureteral reflux, bladder pattern, treatment, time of follow-up, number of clinical visits and urodynamic evaluation performed, final bladder status, surgeries performed.

Results

Between 2018 and June 2023, we have performed 466 urodynamic evaluation in children. From those, 43 were aged < 1 year, mean age of 4.5 months (median 3.5). Diagnosis was myelomeningocele in 31 patients and miscellaneous in 10. From the myelomeningocele group, 23 were operated in-utero and 8 post-natal. The initial bladder pattern in the whole group showed 23 (53%) high risk, 11 normal (25%), 5 hypocontractile (11.6%) and 4 incontinent (9%). Mean follow-up was 24 months, mean age at last urodynamic evaluation (cases with minimum of 2): 37 months, mean urodynamic evaluation per patient: 2. 28 patients perform clean intermittent catheterization, 23 with anticholinergics and 14 are under surveillance. Vesicoureteral reflux was seen in 12/43 cases: 27.9%. Surgery has been performed in 5 patients: 3 urological: 6.9%(bladder augmentation in 2 and vesicostomy in 1). Bladder categorization was for high-risk and normal patterns were 60.86%/26% for in utero and 50%/25% for post-natal repair.

Conclusion

Our study represents a contemporary prospective study that confirmed the elevated incidence of high-risk patterns irrespectively of in-utero or post-natal repair (60.86% and 50%).
We acknowledge the still limited follow-up on this series but this cohort is one of the very few that follow and compare with comparable urodynamic evaluation in-utero and post-natal myelomeningocele repair.