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Bladder Rupture in Premature Infant During Voiding Cystourethrography
Urological Survey PEDIATRIC UROLOGY
Risk Factors for Febrile Urinary Tract Infection in Children With Myelodysplasia Treated by Clean Intermittent Catheterization N. Seki, K. Masuda, N. Kinukawa, K. Senoh and S. Natto, Departments of Urology and Medical Information on Science, Graduate School of Medical Sciences, Kyushu University and Department of Urology, Fukuoka City Medical Center for Sick Children and Infectious Disease, Fukuoka, Japan Int J Urol, 11: 973–977, 2004 Objective: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. Methods: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. Results: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (⬍10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. Conclusion: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia. Editorial Comment: This is a well conceived and well executed study that clearly shows what has been my impression for some time, that as long as the bladder is relatively compliant and is being emptied completely and regularly, UTI is relatively uncommon, even in the myelodysplastic population. If bladder compliance is poor (less than 10 ml/cm H2O), detrusor activity increases, resulting in higher storage pressures, detrusor trabeculation and vesicoureteral reflux. This combination results in increased risk of febrile UTI and scarring, and ultimately upper tract damage becomes more likely. We must focus and then refocus our efforts on keeping bladder pressures low, and ensuring adequate and frequent drainage, particularly as these children age. Douglas A. Canning, M.D.
Bladder Rupture in Premature Infant During Voiding Cystourethrography M. Wosnitzer, D. Shusterman and J. G. Barone, Section of Pediatric Urology, Department of Surgery, Division of Urology, Robert Wood Johnson Medical School, New Brunswick, New Jersey Urology, 66: 432.e13– 432.e14, 2005 We report what we believe to be the youngest patient with bladder rupture during voiding cystourethrography. If voiding cystourethrography needs to be done in a premature infant, the filling pressures should be minimized, multiple filling cycles should be avoided, and the voiding pressures should be minimized by using a small, balloon-less catheter. Editorial Comment: This report valiantly and honestly illustrates a severe complication that can occur when voiding cystourethrography is performed with syringe injection rather than through gravity drainage. Douglas A. Canning, M.D. 0022-5347/06/1752-0727/0 THE JOURNAL OF UROLOGY® Copyright © 2006 by AMERICAN UROLOGICAL ASSOCIATION
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Vol. 175, 727-729, February 2006 Printed in U.S.A. DOI:10.1016/S0022-5347(05)00357-5
Risk Factors for Febrile Urinary Tract Infection in Children With Myelodysplasia Treated by Clean Intermittent Catheterization N. Seki, K. Masuda, N. Kinukawa, K. Senoh and S. Natto, Departments of Urology and Medical Information on Science, Graduate School of Medical Sciences, Kyushu University and Department of Urology, Fukuoka City Medical Center for Sick Children and Infectious Disease, Fukuoka, Japan Int J Urol, 11: 973–977, 2004 Objective: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. Methods: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. Results: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (⬍10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. Conclusion: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia. Editorial Comment: This is a well conceived and well executed study that clearly shows what has been my impression for some time, that as long as the bladder is relatively compliant and is being emptied completely and regularly, UTI is relatively uncommon, even in the myelodysplastic population. If bladder compliance is poor (less than 10 ml/cm H2O), detrusor activity increases, resulting in higher storage pressures, detrusor trabeculation and vesicoureteral reflux. This combination results in increased risk of febrile UTI and scarring, and ultimately upper tract damage becomes more likely. We must focus and then refocus our efforts on keeping bladder pressures low, and ensuring adequate and frequent drainage, particularly as these children age. Douglas A. Canning, M.D.
Bladder Rupture in Premature Infant During Voiding Cystourethrography M. Wosnitzer, D. Shusterman and J. G. Barone, Section of Pediatric Urology, Department of Surgery, Division of Urology, Robert Wood Johnson Medical School, New Brunswick, New Jersey Urology, 66: 432.e13– 432.e14, 2005 We report what we believe to be the youngest patient with bladder rupture during voiding cystourethrography. If voiding cystourethrography needs to be done in a premature infant, the filling pressures should be minimized, multiple filling cycles should be avoided, and the voiding pressures should be minimized by using a small, balloon-less catheter. Editorial Comment: This report valiantly and honestly illustrates a severe complication that can occur when voiding cystourethrography is performed with syringe injection rather than through gravity drainage. Douglas A. Canning, M.D. 0022-5347/06/1752-0727/0 THE JOURNAL OF UROLOGY® Copyright © 2006 by AMERICAN UROLOGICAL ASSOCIATION
727
Vol. 175, 727-729, February 2006 Printed in U.S.A. DOI:10.1016/S0022-5347(05)00357-5