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19–22 APRIL, 2017, BARCELONA, SPAIN
S11: LOWER URINARY TRACT
Moderators: Alberto Parente (Spain), Wolfgang Rösch (Germany)
ESPU Meeting on Thursday 20, April 2017, 16:00–16:58
16:00–16:05
S11-1 (LO)
★
BLADDER CONTRACTILITY INDEX IN POSTERIOR
URETHRAL VALVE: A NEW MARKER FOR EARLY
PREDICTION OF PROGRESSION TO RENAL FAILURE
M S ANSARI
1
, Sandeep NUNIA
2
, Virender SEKHON
3
and Aneesh SRIVASTAVA
4
1) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pedaitric Urolgy, Department of Urology and renal
transplantation, Lucknow, INDIA - 2) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Urology
and renal transplantation, Lucknow, INDIA - 3) Sanjay Gandhi postgraduate Institute of Medical Sciences, Urology and
Renal Transplanation, Lucknow, INDIA - 4) SanjayGandhi postgraduate Institute of Medical Sciences, Pediatric Urology,
Department og Urology and Renal Transplanatation, Lucknow, INDIA
PURPOSE
Nearly two third of the children may progress to chronic kidney disease (CKD) and bladder decom-
pensation (underactive detrusor) near puberty. Bladder stabilization remains the main modifiable
factor which can alter disease progression and ultimate outcome. In this study, we hypothesized
that bladder contractility index (BCI) may be an early marker for future renal deterioration in patients
of PUV.
MATERIAL AND METHODS
Two hundred and seventy patients were included for the analysis. All patients had a baseline
urodynamic study done at 6 months after valve surgery and annually for 5 years. UDS parameters
collected were, bladder contractility index (BCI=PdetQmax+5 Qmax), end filling pressure (EFP),
compliance (ΔC), bladder outlet obstruction index (BOOI= Pdet Qmax - 2 Qmax) and bladder
volume ejection (BVE= Voided volume/total capacity).
Primary end point of the study was an eGFR of < 45 ml/min/1.73m
2
(CKD stage IIIA or more, KDIGO
classification).
RESULTS
Mean follow-up period was 12.5 years and median age of patients at the time of evaluation was
5.8 yrs. At the end of the study, 59 (21.8%) patients had progressed to CKD stage IIIA or more
and lifetime risk for developing CKD stage was 45%. In the multivariate model (Cox regression
analysis), BCI (HR, 0.8; p=0.004), EFP (HR, 2.1; p=0.010) and ΔC (p=0.020) were significantly
associated with the event (i.e. an eGFR of < 45 ml/min/1.73m
2;
; CKD IIIA or more) whereas BOOI
(p=0.053) and BVE (p=0.267) were not.
CONCLUSIONS
Bladder contractility index and end filling pressure are the two important urodynamic indices which
can predict early the long term risk of development of CKD stage III in children with PUV.