PREDICTORS OF UPPER TRACT DETERIORATION AMONG CHILDREN WITH MYELODYSPLASIA

PREDICTORS OF UPPER TRACT DETERIORATION AMONG CHILDREN WITH MYELODYSPLASIA
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Title:PREDICTORS OF UPPER TRACT DETERIORATION AMONG CHILDREN WITH MYELODYSPLASIA
Author/Abstract:
Ma. Victoria C. EstaƱol, MD; Jason L. Letran, MD; Nilo delos Santos, MD and David T. Bolong, MD

Section of Urology, Department of Surgery, University of Santo Tomas Hospital.

Introduction: Upper urinary deterioration is a common sequela of neurogenic bladder dysfunction in children with myelodysplasia. Therefore, it deserves attention and thorough investigation. Early identification of factors that can contribute to development of upper tract deterioration is ideal. Objective: To identify risk factors in the development of upper tract deterioration and to predict those children who will most likely develop under tract deterioration. Materials and Methods: A cross sectional study of all pediatric patients with myelodsyplasia enrolled in a multidisciplinary surveillance program at our institution was done. The development of upper tract deterioration was determined by progression of hydronephrosis and/or vesicoureteral reflux, one grade higher from previous study. Factors evaluated were age, sex, presence of voiding dysfunction, recurrent urinary tract infection (UTI), presence of hydronephrosis, vesicoureteral reflux, detrusor - sphincter dyssynergia, detrusor areflexia, and a detrusor leak point pressure of >40cm H20 and the early institution of clean intermittent catheterization (CIC). Results: A total of 100 patients were included in the study. Forty two percent developed upper tract deterioration. The most significant factor was the presence of vesicoureteral reflux. When multiple logistic regression analysis was done, the other factors noted to be significant were age, presence of recurrent UTI, hydronephrosis, vesicoureteral reflux, clean intermittent catheterization and >40 cm H20 detrusor leak point pressure. Conclusion: Being aware of the predictive value of these risk factors, one will be able to direct management. We found that acceptance of any high risk parameter will identify most patients at risk of upper tract deterioration. As a consequence of this strategy, we will be able to predict the outcome of patients with myelodysplasia.

Key words: myelodysplasia, upper tract deterioration.
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