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신경인성 방광 환자에서 방광확대술 후 신장 기능의 장기간 추적 결과 |
| 연세대학교 의과대학 비뇨의학교실 |
| 박지은, 김상운, 이용승, 한상원 |
Purpose
To investigate long term outcome of renal function after augmentation cystoplasty in children with neurogenic bladder and determine prognostic factors for renal deterioration.
Materials and methods
Of 87 patients who underwent augmentation cystoplasty between June 2006 and June 2016 in our hospital, sixty-four patients were with neurological origin. After exclusion of 7 patients who were loss to follow up and with short-term follow up duration less than 5 years, a total of 57 patients were included in our study.
Results
The mean age at augmentation cystoplasty was 11.6 years old (range, 5-35) and average duration of follow up after surgery was 8.44 years (range, 5-30). Thirty-four patients were male, and 23 were female. Among 57 patients, thirty-two (56.1%) were diagnosed as meningomyelocele and 18 (31.5%) were with lipomeningomyelocele. The mean of preoperative creatine and e-GFR were 0.72±0.54 mg/dL and 103.74±42.47ml/min respectively. When classified as CKD grade, the number of grade I before surgery was 36 (63.2%), followed by 15 for II (26.3%), 4 for III (7.0%), and 2 for IV (3.5%). At last visit with long-term follow up, creatine increased to 1.04±1.38mg/dL (p=0.034), but e-GFR was 109.78 ±43.88ml/min), showing no difference compared to preoperative level (p=0.180). At last visit, 1 patient (1.8%) was CKD grade III, 3 patients (5.3%) were IV, and 2 patients (3.5%) were V. A total of three patients were performing dialysis on final visit, with average of 121 months of interval to postoperative dialysis. Preoperative factors were analyzed and compared for patients showing severe renal dysfunction above CKD grade IV and others during follow up, and there was a significant difference in the preoperative creatine level (2.02±0.98 vs. 0.59±0.27mg/dL, p=0.031) and e-GFR (38.84±18.23ml/min vs 111.63±37.53, p<001). The preoperative e-GFR predicted severe renal dysfunction above CKD grade IV (ROC survival curve), and the optimal cutoff level of preoperative e-GFR was 62 (sensitivity 100%, specificity 94.2%).
Conclusion
Even after successful augmentation cystoplasty, some patients proceeded with renal failure and severe renal dysfunction during long-term follow up. Considering preoperative-GFR <62mL/min could serve as a predictor of severe renal dysfunction, we should not miss the right time of intervention for maintaining renal function. |
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keywords : Neurogenic bladder, cystoplaty, renal function |
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