title: Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.
abstract: OBJECTIVE
  We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value.
  
  
  METHODS
  We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes.
  
  
  RESULTS
  Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss.
  
  
  CONCLUSIONS
  With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.
authors.affiliation: Childrens Hospital Los Angeles, Department of Urology, University of Southern California, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Kurzrock
authors.forename: S
authors.initials: S
authors.lastname: Polse
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014563:Urodynamics