title: Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program.
abstract: OBJECTIVE
  Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines.
  
  
  METHODS
  Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth.
  
  
  RESULTS
  Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up.
  
  
  CONCLUSIONS
  High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage.
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Paediatrics, Linköping University, SE 581 85 Linköping, Sweden. peter.wide@lio.se
authors.forename: Peter
authors.initials: P
authors.lastname: Wide
authors.forename: Gunilla
authors.initials: G
authors.lastname: Glad Mattsson
authors.forename: Sven
authors.initials: S
authors.lastname: Mattsson
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009313:National Health Programs; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications* / Q000175:diagnosis; D013548:Sweden; D001743:Urinary Bladder / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods*; D014563:Urodynamics / Q000502:physiology