Neurogenic Bladder Scoring System: Identifying Patients at Risk for Renal Deterioration and Need for Surgical Intervention

Neurogenic Bladder Scoring System: Identifying Patients at Risk for Renal Deterioration and Need for Surgical Intervention
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Title:Neurogenic Bladder Scoring System: Identifying Patients at Risk for Renal Deterioration and Need for Surgical Intervention
Author/Abstract:

Sigfred Ian R. Alpajaro, MD and David T. Bolong, MD, FPUA
Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Myelomeningocele (MMC) is almost universally associated with neurogenic bladder dysfunction
(NBD). Renal decline and eventual failure are the most pervasive issues. Unfortunately, no unifying
system based on basic clinical, ultrasonographic and urodynamic factors can guide the urologist in
treatment in timely treatment decisions.

Objective: This aimed is to develop a scoring system predictive of progressive renal deterioration and
need for surgery in MMC patients with NBD.

Materials and Methods: A previous analysis identified factors that portend poor long-term outcomes
(progressive renal deterioration and eventual need for surgery). Based on the odds ratio obtained, a
scoring system was created, with parameters including UTI, hydronephrosis, thickened bladder wall,
low bladder compliance, elevated Detrussor Leak Point Pressure, Christmas tree bladder pattern,
and vesico-ureteral reflux. The discriminatory ability of the model was assessed by the area under the
receiver operating characteristic (ROC) curve.

Results: The total risk score of each patient ranged from 3 to 41 (mean 17.28 ± 10.84). Mean score for
non-surgery group is 10.02 ± 6.52 (Range: 3 - 33) while for surgery group, the mean score is 24.53 ±
9.37 (Range: 5 - 41). The mean score of the groups were statistically significant, having a p-value of
<0.00001. Surgery group showed a higher total risk score as compared to the non-surgery group. The
area under the curve is 0.908 (Std. Error=0.04; 95% CI: 0.84 - 0.98) showing a good discriminatory
power. The positivity cutoff point was set at a score of 14, since there is good sensitivity (87.50%) and
good specificity (72.50%) at the said cutoff point. The likelihood ratio for a positive result is equal to
5.0, while the likelihood ratio for a negative result is 0.15.

Conclusions: We have developed a clinically applicable scoring system with the aim of identifying
MMC patients with NBD who are at risk for renal deterioration and eventual surgery in the future.
Patients who have scores beyond the cut off point should be offered a more aggressive management.
More experience with its use in the clinical setting is necessary to further validate the system.

Key words: myelomeningocele, spina bifida, scoring system

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