{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T02:26:33Z","timestamp":1740104793024,"version":"3.37.3"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T00:00:00Z","timestamp":1519776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Neurogenic bladders (NGB) with detrusor leak point pressures &gt;40\u2009cm H<jats:sub>2<\/jats:sub>O (dLPP\u2009&gt;\u200940) have been associated with deterioration of renal function in children with myelomeningocele. For these children, careful pressure management preserves renal function. However, similar evidence is lacking in adult congenital urology (ACU) patients with NGB. We describe renal functional outcomes of non\u2010surgical management of adults with dLPP\u2009&gt;\u200940 or premicturition detrusor pressure (PMDP) &gt;40\u2009cm H<jats:sub>2<\/jats:sub>O, consisting of close follow\u2010up with urodynamic studies (UDS) and renal ultrasound (RUS), paired with adjustments to clean intermittent catheterization (CIC) frequency, anticholinergics, and addition of onabotulinumtoxinA toxin (BTX) injection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the UDS of all patients at an ACU clinic from 2011 to 2016. Patients with dLPP\/PMDP\u2009&gt;\u200940\u2009cm who elected for non\u2010surgical management were included. We describe their management and renal functional outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 33\/42 patients with dLPP\/PMDP\u2009&gt;\u200940 elected for non\u2010surgical management. 28\/33 (85%) were successfully managed without bladder augmentation or urinary diversion at follow\u2010up of nearly 3 years. The median index dLPP\/PMDP was 49\u2009cm H<jats:sub>2<\/jats:sub>O (IQR 44, 63) and final dLPP\/PMDP was 28 (IQR 18, 43). There was a significant decrease in dLPP\/PMDP and increase in bladder compliance between index and final UDS (<jats:italic>P\u2009<\/jats:italic>&lt;\u20090.001). No patients advanced their CKD stage and 6\/10 with baseline hydronephrosis had improvement or resolution of hydronephrosis with non\u2010surgical management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A non\u2010surgical protocol for ACU patients with NGB and dLPP\/PMDP\u2009&gt;\u200940, utilizing CIC, anticholinergics, and BTX is safe and effective when coupled with coordinated care and close follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.23535","type":"journal-article","created":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T10:23:01Z","timestamp":1519813381000},"page":"1943-1949","source":"Crossref","is-referenced-by-count":5,"title":["Clinical outcomes of non\u2010surgical management of detrusor leak point pressures above 40\u2009cm water in adults with congenital neurogenic bladder"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6977-5280","authenticated-orcid":false,"given":"Giulia I.","family":"Lane","sequence":"first","affiliation":[{"name":"Department of Urology University of Minnesota Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1599-2703","authenticated-orcid":false,"given":"Ronak A.","family":"Gor","sequence":"additional","affiliation":[{"name":"Department of Urology University of Minnesota Minneapolis Minnesota"},{"name":"Gillette Lifetime Specialty Healthcare St. Paul Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna","family":"Katorski","sequence":"additional","affiliation":[{"name":"Gillette Lifetime Specialty Healthcare St. Paul Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean P.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Urology University of Minnesota Minneapolis Minnesota"},{"name":"Gillette Lifetime Specialty Healthcare St. Paul Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)54449-3"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)42084-2"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)37254-3"},{"key":"e_1_2_6_5_1","unstructured":"BlokB PannekJ Castro DiazD et al.2017; European Association of Urology Guidelines on Neuro\u2010Urology.https:\/\/uroweb.org\/guideline\/neuro\u2010urology\/Accessed 12 Dec 2017."},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.06.021"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2009.06.002"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/13668250.2013.788690"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2014.08.022"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0275"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2017.04.006"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.01.021"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22546"},{"volume-title":"Urodynamics","year":"2006","author":"Abrams P","key":"e_1_2_6_14_1"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005392-199805000-00084"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2017.04.004"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"e_1_2_6_18_1","first-page":"1","article-title":"Kidney disease: improving global outcomes (KDIGO) CKD work group. 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