title: Transverse myelitis in children: long-term urological outcomes.
abstract: OBJECTIVE
  Urological complications are well documented in patients with traumatic spinal cord injury. We examined the long-term urological outcomes in a large population of children affected by transverse myelitis.
  
  
  METHODS
  We retrospectively reviewed the medical history, imaging studies and urodynamic findings in 22 children with transverse myelitis. Age at disease onset ranged from 3 months to 18 years (average 8.8 years).
  
  
  RESULTS
  At a mean followup of 7.1 years 19 patients (86%) had persistent bladder dysfunction and 17 (77%) had persistent bowel dysfunction. Initial evaluation at least 1 month after disease onset revealed detrusor overactivity in 59% of patients, detrusor external sphincter dyssynergia in 41%, low compliance in 47% and detrusor leak point pressure greater than 40 cm water in 12%. Functional motor recovery and absence of lower extremity spasticity did not reflect normal urodynamic findings. Of the 19 patients with imaging available for review 5 (26%) had upper tract changes. One patient had development of chronic renal insufficiency. Low compliance (p = 0.02) and upper tract changes (p = 0.1) were more frequent in patients who started clean intermittent catheterization more than 2 years after disease onset.
  
  
  CONCLUSIONS
  Persistent bowel and bladder dysfunction is common in transverse myelitis. Urodynamic abnormalities may be present despite normal neurological examination and absence of urinary symptoms. All pediatric patients with transverse myelitis require baseline renal ultrasound and urodynamic evaluation to guide treatment. Early institution of clean intermittent catheterization appears to preserve bladder compliance and decrease upper tract disease, and should be instituted at disease onset.
authors.affiliation: Department of Urology, University of California Davis Children's Hospital, Sacramento, California, USA.
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Tanaka
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Stone
authors.forename: Eric A
authors.initials: EA
authors.lastname: Kurzrock
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009187:Myelitis / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D014570:Urologic Diseases / Q000209:etiology* / Q000503:physiopathology