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Risk Factors For Acute Urinary Retention In Pediatric Cerebral Palsy Patients
Sidharth Deepak Sharma, BS1, David G. Gelikman, BS
1, Abhishek Seth, MD
2, Pamela Ellsworth, MD
2.
1University of Central Florida College of Medicine, Lake Nona, FL, USA, 2Nemours Children's Hospital, Lake Nona, FL, USA.
IntroductionCerebral palsy (CP) is a neurological disorder that primarily affects movement and can lead to lower urinary tract dysfunction and acute urinary retention (AUR). While the occurrence of AUR in CP patients is well documented, the influence of age on AUR risk in the pediatric CP population has not been thoroughly evaluated. Our study aims to investigate the role of age and other factors such as ambulatory status, constipation history, and urinary tract infection (UTI) history in AUR risk among pediatric CP patients.
MethodsWe conducted a retrospective case-control study of 86 pediatric CP patients, aged 0-18 years, treated between 2017 and 2023. The patients were divided into two groups: 43 cases with both CP and AUR and 43 age- and sex-matched controls with CP but no history of AUR. We analyzed data including age at first AUR episode, ambulatory status, surgical history, history of UTIs and constipation. A multivariate logistic regression was used to evaluate the potential predictors of AUR.
ResultsThe mean age of the cohort was 11.91 years, with an average age at first AUR episode being 9.46 years for case patients (Table 1). Overall, 53.5% of our population consisted of males (n=46), with cases and controls both consisting of 53.5% males (n=23). Approximately 76.7% (n=66) of
our study patients had spastic quadriplegic CP, while the rest consisted of patients with other forms of CP, such as spastic diplegic or triplegic CP. There were no significant differences between ambulatory status and surgical history between cases and controls. Cases had a significantly higher constipation and UTI history compared to controls (p < .0001). Our logistic regression model demonstrated that ambulatory status was not significantly predictive of AUR (p = .968).However, a history of UTI (P<.001) and constipation (P<.001) were both independently significant predictors of AUR.
ConclusionsThis study highlights that pediatric CP patients typically encounter AUR around 9.46 years of age. Ambulatory status does not affect AUR risk, but a history of UTIs and constipation are significant independent risk factors. These findings suggest the need for proactive urological screening and management of CP patients from an early age, particularly for those with a history of UTIs and constipation, to prevent AUR and its potential complications.
FundingNone
TableTable 1. Descriptive statistics comparing cases and controls and multivariate logistic regression predicting acute urinary retention
| | | | |
| Variable | Overall(n = 86) | Cases(n = 43) | Controls(n = 43) | p-value |
| Mean Age (years) | 11.91 (3.99) | 11.91 (4.02) | 11.91 (4.02) | 1 |
| Mean Age at First AUR Episode (years) | N/A | 9.46 (4.65) | N/A | |
| Sex | | | | 1 |
| Male | 46 (53.5%) | 23 (53.5%) | 23 (53.5%) | |
| Female | 40 (46.5%) | 20 (46.5%) | 20 (46.5%) | |
| Ambulatory Status | | | | .444 |
| Spastic quadriplegic | 66 (76.7%) | 35 (81.4%) | 31 (72.1%) | |
| Other† | 20 (23.3%) | 8 (18.6%) | 12 (27.9%) | |
| History of UTI | 28 (32.6%) | 23 (53.5%) | 5 (11.6%) | < .0001 |
| History of Constipation | 63 (73.3%) | 41 (95.4%) | 22 (51.2%) | < .0001 |
| History of Surgery | | | | |
| Abdominal surgery | 9 (10.5%) | 9 (20.9%) | 0 | .002 |
| Combination surgery | 5 (5.8%) | 2 (4.7%) | 3 (7.0%) | 1 |
| Hip surgery | 13 (15.1%) | 3 (7.0%) | 10 (23.3%) | .068 |
| Spine surgery | 23 (26.7%) | 12 (27.9%) | 11 (25.6%) | 1 |
| None | 36 (41.9%) | 17 (39.5%) | 19 (44.2%) | .827 |
| | | | |
| Variable | Unadjusted OR (95% CI) | p-value | Multivariate OR (95% CI) | p-value |
| Ambulatory status | | .310 | | .968 |
| Spastic quadriplegic | 1.69 (0.62 – 4.84) | | 0.97 (0.26 – 3.60) | |
| Other† | 1.00 (reference) | | 1.00 (reference) | |
| History of UTI | 8.74 (3.08 – 29.26) | < .001 | 10.17 (2.87 – 49.42) | .001 |
| History of Constipation | 19.57 (5.11 – 129.6) | < .001 | 22.54 (5.00 – 177.7) | < .001 |
AUR – acute urinary retention, UTI – urinary tract infection, OR – odds ratio, CI – confidence interval
†Other includes grouped patients with low overall categorical counts: spastic diplegic (n = 6), quadriplegic (n = 3), tetraplegic (n = 3), diplegic (n = 2), left spastic plegic (n = 1), hemiplegic (n = 2), and unspecified (n = 3)
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