BACKGROUND: To compare whether children with neurogenic bladder (NB) have upper urinary tract damage (UUTD), and to explore the predictive value of Multi-modal ultrasound (MMU) in children with NB.
METHODS: From January 2022 to December 2023, 87 children with NB admitted to the First Affiliated Hospital of Zhengzhou University were examined by MMU. Measurements upon bladder fullness included vesical volume (VV), bladder wall thickness (BWT), shear wave velocity (SWV) of the anterior wall, resistance index (RI), and vascularization index (VI). During bladder emptying, VV and anterior wall SWV were measured, and ultrasound bladder compliance (ΔC) was calculated. The anteroposterior diameter (APD) of bilateral renal pelvis and ureter diameter (UD) were also measured. According to the classification criteria, NB children were divided into UUTD group and non-upper urinary tract damage (NUUTD) group. Analyzed the differences in clinical data and related examinations between the groups, screened out independent risk factors, established an early warning model based on the independent risk factors, and compared the prediction efficiency of the model against urodynamic study (UDS) for UUTD.
RESULTS: (1) There were no significant differences in gender, age and body mass index between the UUTD group (47 cases) and the NUUTD group (40 cases) (all P>0.05). (2) In UUTD group, the total glomerular filtration rate (tGFR) was (70.45±16.17) mL/min, the incidence of hydronephrosis was 38.30%, and the incidence of bilateral ureteral dilatation was 23.40%. No morphological changes were found in the imaging examination of the urinary system in the NUUTD group, and its tGFR was (100.55±16.27) mL/min. There was a significant difference in tGFR between the groups(P<0.05). (3) The filling VV, emptying VV, mean BWT, filling SWV, emptying SWV, VI, mean RI, ΔC, maximum bladder capacity (MCC), maximum detrusor pressure during filling (Pdet.max), bladder compliance (BC) and detrusor leakage point pressure (DLPP) in NUUTD group were (218.43±87.53)mL,(14.62±6.14)mL,(3.08±0.65)mm,(2.64±0.54)m/s,(1.88±0.41)m/s,(6.20±1.04)%,(0.68±0.04),(147.58±49.18)mm²·s,(309.50±66.54)mL,(59.83±19.79)cmH2O,(25.80±10.34)mL/cmH2O,(34.00±6.16)cmH2O, respectively. Compared with NUUTD group, the UUTD group showed decreased filling VV(167.21±85.63)mL, ΔC(78.49±31.86)mm²·s,VI(5.01±0.81)%, MCC (255.32±75.10)mL and BC(12.57±6.44)mL/cmH2O, with increased emptying VV(19.50±7.65)mL, mean BWT(4.02±0.82)mm, filling SWV(3.99±1.07)m/s, emptying SWV(2.15±0.35)m/s, mean RI(0.70±0.08), Pdet.max (75.94±26.23)cmH2O and DLPP(48.13±12.61)cmH2O (all P<0.05).(4) The decrease of BC(OR:0.841,95% CI:0.562 ~ 1.256,P=0.045), ΔC (OR:0.427,95% CI:0.202 ~ 0.904,P=0.026)and VI(OR:0.461,95% CI:0.091 ~ 2.325,P=0.010) and the increase of DLPP(OR:1.139,95% CI:0.894 ~ 1.451,P=0.040), filling SWV (OR:1.895,95% CI:1.082 ~ 3.321,P=0.007)and mean BWT (OR:1.191,95% CI:0.850 ~ 1.669,P=0.025)were independent risk factors for UUTD. Among MMU parameters, filling SWV had the highest prediction efficiency for UUTD, with a threshold of 3.33m/s, sensitivity of 72.34% and specificity of 92.50%.
CONCLUSIONS: MMU can well predict the occurrence of UUTD in children with NB, and filling SWV has the highest prediction efficiency.
