ESPN 50th Annual Meeting

ESPN 2017


 
BLADDER DYSFUNCTION REASON OF KIDNEY FAILURE; LEGS LENGTH DISCREPANCY CAN BE AN AWARENESS SYMPTOM OF BLADDER DYSFUNCTION
VALBONA STAVILECI 1 DESTAN KRYEZIU 1 SVEN MATTSSON 3 DIAMANT SHTIZA 2 IRENA PALLOSHI 2 ARLINDA MALOKU 1 PRANVERA GJYSHINCA 1

1- UNIVERSITY CLINICAL CENTER OF KOSOVA
2- UNIVERSITY CLINICAL CENTER OF TIRANA
3- UNIVERSITY OF LINKOPING,SWEDEN
 
Introduction:

Stigma of urinary incontinence is still present. Approximately 6% of patients undergoing renal transplant each year have ESRD due to lower urinary tract abnormality.

Orthopedist approach for Lower extremities discrepancy usually is tightly surgical repair, without broader physical examination, which would identify the bladder function problem and preserve kidney function.

 

 

 

Material and methods:

 A boy 16 years, presented with ESRD Cre: 1080 and Urea:94. Incontinent and constipated, both paretic legs ( left shorter with contractures), couldn’t walk properly, spinal dysraphism. Leg orthopedic operation  three years before presentation. Nurologically FVM gr 3, RTM are lacking. Severe hydronephrotic on ultrasound and with chronic pyelonephritis. Large bladder with 2.5 L urine.

Results:

 Second day after catheterization developed Hemorrhagic cystitis. Cystrometry: no bladder contraction during feeling. At 500 ml leaked with cough, and on 600 ml leaked continuously. Pressure almost 15 mmH2O. No sensation. Bladder cooling test positive. He felt heat water, had pain on feeling, no contraction. Cold water: during feeling no cold sensation, severe pain and contractions (pressure was 58mmH2O maximal). Not able to present an uroflow curve, micturation: 80 ml with straining, 525 ml residuals. 

During CIC he was wet even with 150-200 ml urine. MRI: terminal meningocystocele. Sacrum ends at S2 (partial sacrum agenesis), dural sac is bulging downwards and frontally in a few cysts. It is difficult to exactly see where conus ends and if there is a syringohydromyelia.

 An indwelling catheter on free drainage is no guarantee of a constantly low intravesical pressure, cause of phasic bladder contractions which occur despite catheter drainage will damage upper urinary tract.

Conclusions:

Children with NBD require multidisciplinary team care: pediatricians, neurosurgeon, urologist, nephrologists, orthopedics, allied medical specialists.

Treatment aim: to achieve a low-pressure bladder and prevent posttransplant infection. Options: conservative modalities:clean intermittent catheterization and bladder relaxants. Invasive modalities: bladder augmentation, intestinal conduit, or external sphincterotomy.