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Resolution of Perinatal Idiopathic Hydronephrosis At Year 1, 2 And 3 In Children With Myelomeningocele And Aggressive Bladder Management
Yi Li, Medical student, Bryan Pham, Medical student, Dung Pham, M.D, Christian Douthit, Medical student, Stephen Li, Medical student, Brittany Wise, Medical student, Christopher Nguyen, College student, Edmond Gonzales, M.D, David Roth, M.D.
Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
BACKGROUND: Antenatal hydronephrosis occurs in about 1-3% of the general population. In children with myelomeningocele (MM), it can be as high as 20%. Perinatal hydronephrosis may have no clinical significance. However a diagnosis of hydronephrosis can cause much anxiety to the patient’s family. We seek to determine the incidence ofhydronephrosis and its resolution rate in children with MM and aggressive bladder management.
METHODS: We retrospectively reviewed patients seen in the MM clinic over the last 5 years.We included only patients with a renal ultrasound (RUS) performed before or immediately after spinal closure and who also had a consecutive RUS performed 1, 2 and 3 years of age. Hydronephrosis data was extracted from radiology reports and patient cohorts were stratified into groups with or without hydronephrosis. We did not stratify based on the degree of hydronephrosis. We excluded any patients with vesicoureteral reflux, ureteral-vesico obstruction, recurrent urinary tract infections, solitary kidney, any congenital cystic or dysplastic kidney, or ureteropelvic obstruction. All patients underwent early cystometrogram evaluation and clean intermittent catherization, with or without anticholinergics, was initiated for any or all of these parameters: poor compliance, inability to empty, pressures greater than 40 cm of H20, and detrusor sphincter dyssynergia.
RESULTS: A total of 88 patients were available for analysis. Hydronephrosis was present in 31% of patients.At 1, 2 and 3 years 40%, 22% and 4% of the hydronephrosis resolved, respectively. The greatest resolution rate was seen between birth and 1 year of age and the lowest rate of resolution was seen between years 2 and 3 (2%). A total of 33% did not have resolution of the hydronephrosis by year 3. There was no difference in the incidence or the resolution of hydronephrosis between males and females (p > 0.05).
CONCLUSIONS: A significant percentage of children with MM have hydronephrosis before or after closure of the spinal cord. However, with aggressive bladder management 66% of these hydronephrosis resolve with 62% occurring by year 2. Our data helps to counsel patient’s parents about the natural history of perinatal hydronephrosis.
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