Neurourology and urodynamics · 2026
Unformed Conus Medullaris in Children With Spinal Lipoma Is a Risk Factor Requiring Clean Intermittent Catheterization.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Takeda Shinako, Kawamorita Naoki, Shironomae Tsubasa, Eriguchi Tomohiro, Ainoya Keiko, Sakai Kiyohide, Satake Yohei, Takemoto Jun, Kimiwada Tomomi, Hayashi Toshiaki, Namima Takashige, Ito Akihiro
Аннотация
BACKGROUND: Spina bifida is the most common cause of neurogenic lower urinary tract dysfunction (NLUTD) in children. Spinal lipoma, a form of occult spina bifida, exhibits variable functional outcomes and unpredictable progression, which may delay timely urinary management. The requirement for clean intermittent catheterization (CIC) also imposes a substantial and lasting impact on the social lives of affected children and their caregivers. Consequently, identifying the predictors of NLUTD necessitating CIC is of significant clinical interest. This study aimed to identify the risk factors associated with the need for CIC in patients with spinal lipoma.
METHODS: A retrospective observational study was conducted on 116 patients aged ≤ 18 years who underwent videourodynamics (VUDS) and received treatment at Miyagi Children's Hospital between April 2007 and April 2022. We excluded patients with other complications, such as anorectal malformations. The study evaluated the necessity for CIC using magnetic resonance and computed tomography imaging, VUDS bladder function, and clinical data, including medication details, duration, and timing of untethering procedures.
RESULTS: Among the 116 patients analyzed (50 boys and 66 girls), 47 (41%) required CIC at the time of assessment, with a median introduction age of 43.7 months. Patients were categorized into five subtypes of the Arai's classification: 33 with dorsal type, 21 with transitional type, 30 with lipomyelomeningocele (LMMC), 28 with caudal type, and four with filar type. CIC was required in 5 dorsal type, 14 transitional type, 18 LMMC, and 10 caudal type patients, whereas no filar type patients required CIC. Unformed conus medullaris was present in 73 patients (62.9%), and sacral agenesis in 50 patients (43.1%). Proportional hazard model analysis identified unformed conus medullaris (HR 11.5; 95% CI 3.53-37.7; p < 0.0001), detrusor overactivity (DO) (HR 2.23; 95% CI 1.07-4.62; p = 0.0307), and detrusor-sphincter dyssynergia (DSD) (HR 2.34; 95% CI 1.01-5.41; p = 0.0465) on initial VUDS as significant risk factors for the requirement of CIC.
CONCLUSION: Patients with an unformed conus medullaris are at a high risk of NLUTD requiring CIC and warrant close monitoring. The presence of DO and DSD on VUDS likely reflects underlying congenital neural tissue dysgenesis, indicating that abnormalities during the junctional neurulation stage of spinal cord development are strongly associated with NLUTD.
METHODS: A retrospective observational study was conducted on 116 patients aged ≤ 18 years who underwent videourodynamics (VUDS) and received treatment at Miyagi Children's Hospital between April 2007 and April 2022. We excluded patients with other complications, such as anorectal malformations. The study evaluated the necessity for CIC using magnetic resonance and computed tomography imaging, VUDS bladder function, and clinical data, including medication details, duration, and timing of untethering procedures.
RESULTS: Among the 116 patients analyzed (50 boys and 66 girls), 47 (41%) required CIC at the time of assessment, with a median introduction age of 43.7 months. Patients were categorized into five subtypes of the Arai's classification: 33 with dorsal type, 21 with transitional type, 30 with lipomyelomeningocele (LMMC), 28 with caudal type, and four with filar type. CIC was required in 5 dorsal type, 14 transitional type, 18 LMMC, and 10 caudal type patients, whereas no filar type patients required CIC. Unformed conus medullaris was present in 73 patients (62.9%), and sacral agenesis in 50 patients (43.1%). Proportional hazard model analysis identified unformed conus medullaris (HR 11.5; 95% CI 3.53-37.7; p < 0.0001), detrusor overactivity (DO) (HR 2.23; 95% CI 1.07-4.62; p = 0.0307), and detrusor-sphincter dyssynergia (DSD) (HR 2.34; 95% CI 1.01-5.41; p = 0.0465) on initial VUDS as significant risk factors for the requirement of CIC.
CONCLUSION: Patients with an unformed conus medullaris are at a high risk of NLUTD requiring CIC and warrant close monitoring. The presence of DO and DSD on VUDS likely reflects underlying congenital neural tissue dysgenesis, indicating that abnormalities during the junctional neurulation stage of spinal cord development are strongly associated with NLUTD.