Predictive value of multimodal ultrasound for upper urinary tract damage in children with neurogenic bladder
Objective To explore the predictive value of multimodal ultrasound(MMU)for upper urinary tract damage(UUTD)in children with neurogenic bladder(NB).Methods This was a case-series study.From January 2022 to December 2023,87 children with NB admitted to the First Affiliated Hospital of Zhengzhou University were examined by MMU.During the filling of bladder,vesical volume(VV),bladder wall thickness(BWT),shear wave velocity(SWV)of the anterior wall,resistance index(RI),and vascularization index(VI)were measured.After the emptying of bladder,VV and anterior wall SWV were measured,and ultrasound bladder compliance(△C)was calculated.The anterior posterior diameter(APD)of the renal pelvis and ureteral diameter(UD)were also measured.According to the upper/lower urinary tract dysfunction classification criteria,NB children were divided into a UUTD group and a non-UUTD(NUUTD)group.The differences in clinical data and related examinations between the 2 groups were analyzed to screen out independent risk factors,and an early warning model was established based on these factors.The prediction efficiency of the model and the urodynamic study(UDS)for UUTD was compared.Results(1)There were 47 children in the UUTD group and 40 children in the NUUTD group.There was no significant difference in gender,age and body mass index between the 2 groups(all P＞0.05).(2)In the 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 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 2 groups(P＜0.05).(3)The filling VV,emptying VV,mean BWT,filling SWV,emptying SWV,VI,mean RI,△C,maximum cystometric capacity(MCC),maximum detrusor pressure during filling(Pdet.max),bladder compliance(BC),and detrusor leak point pressure(DLPP)in the 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(1 cmH2O=0.098 kPa),(25.80±10.34)mL/cmH2O,and(34.00±6.16)cmH2O,respectively.Compared with the NUUTD group,the UUTD group showed decreased filling VV[(167.21±85.63)mL],△C[(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],and 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 decreased BC(OR=0.841,95％CI:0.562-1.256,P=0.045),△C(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 increased 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 3.33 m/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.
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