title: Is 40 cm H2O detrusor leak point pressure cut-off reliable for upper urinary tract protection in children with myelodysplasia?
abstract: The purpose of this study, is to find out the most accurate cut-off level for the detrusor leak point pressure (DLPP) in terms of upper urinary tract (UUT) protection in a cohort of children with myelodysplasia.
  
  
  
  One hundred and ninety-three children with myelodysplasia were included in the study based on the availability of urological evaluation at age of 3 years. Children were assigned to one of two groups-those who had UUT damage at age 3 (group 1, n: 70) and those without UUT changes (group 2, n: 123), and compared.
  
  
  
  Urological follow-up data revealed higher incidences of febrile urinary tract infections and secondary tethering of the spinal cord in group 1. No statistically significant difference was determined between group 1 and group 2 in terms of DLPP values (median 42.5 vs. 39.5 cm H2O, respectively, P = 0.087). Analysis of different cut-off values showed that DLPP above 20 cm H2O had a higher sensitivity for UUT damage (91.4%). A normal UUT was found in 56.5% and 62.2% of children with DLPP between 20 and 40 cm H2O, and with DLPP over 40 cm H2O, respectively.
  
  
  
  Present study showed that more than half of the children with myelodysplasia had normal UUT function even with a DLPP of 40 cm H2O and over. Thus, DLPP, is not the sole decision making parameter to rely for more invasive therapies in children with myelodysplasia. On the other hand, a DLPP cut-off value of 20 cm H2O showed a higher sensitivity to predict UUT damage instead of 40 cm H2O. Neurourol. Urodynam. 36:759-763, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Tufan
authors.initials: T
authors.lastname: Tarcan
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Cagri Akin
authors.initials: CA
authors.lastname: Sekerci
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Akbal
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Tinay
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Yiloren
authors.initials: Y
authors.lastname: Tanidir
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sahan
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Bahadir
authors.initials: B
authors.lastname: Sahin
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Top
authors.affiliation: Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Ferruh
authors.initials: F
authors.lastname: Simsek
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*; D014564:Urogenital Abnormalities / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D013520:Urologic Surgical Procedures
keywords: detrusor leak point pressure; myelodysplasia; neurogenic bladder; upper urinary tract deterioration