Intractable Voiding Dysfunction and High Pressure Bladder: Evaluation of Patients with Normal and Abnormal Spinal Imaging (original) (raw)
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Marmara Medical Journal, 2017
Objectives: To evaluate the presence of upper urinary tract deterioration (UUTD) and accompanying pathologies in children treated with the diagnosis of non-neurogenic bladder-sphincter dysfunction (NNBSD). Patients and Methods: We retrospectively reviewed the medical records of 316 consecutive patients with NNBSD who were treated. All cohort were grouped into two: Group I (Treatment success; n=284), Group II (Treatment failure with any form of occult spinal pathology; n=32). Thirty-four children with treatment-failure and normal magnetic resonance imaging (MRI) findings were excluded. Groups were compared for pre-and posttreatment pediatric lower urinary tract symptom score (PLUTSS), presence of UUTD and urodynamic findings. Results: The mean PLUTSS was significantly less in Group I compared with Group II at pre-treatment and 3 months thereafter the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14 and 18 ± 3.4, respectively p<0.01). The mean cystometric capacities and detrusor leak point pressure (DLPP) of Group II prior to initial treatment and after 6 months of the untethering surgery were found to be 194, 267 mL and 28, 12cm H2O, respectively (p<0.05). Presence of UUTD was significantly correlated with DLPP >20 cm H2O and presence of vesicoureteral reflux (VUR). Conclusion: UUTD in NNBSD is more common in children with occult spinal pathology, than in those without.
Journal of Pediatric Urology, 2014
Journal of Pediatric Urology (2014) 10, 627e633 age at surgery was 59.3 months (range 2e277 months) with an average follow-up of 7.0 years (range 1e16 years). At latest follow-up, 47 (80%) patients were continent while 12 (20%) were either incontinent or utilizing clean intermittent catheterization (CIC). Statistical analysis revealed that age of untethering, type of cutaneous lesion, level of conus, presence of hydronephrosis, and high-grade vesicoureteral reflux (VUR) were not independent predictors of continence. In patients with a cutaneous lesion who were asymptomatic, 19/20 obtained continence post-TCR (*p Z 0.036). In patients who were old enough to assess continence pre-TCR, 14/25 patients were continent pre-TCR and 11/25 were incontinent. Of the 14 who were continent pre-TCR, all remained continent post-TCR (*p Z 0.002). Of the 11 who were incontinent pre-TCR, five (45%) eventually became continent post-TCR. Assessment of urodynamic data revealed that neither pre-nor post-TCR urodynamics predicted continence status. Conclusion: Isolated cutaneous lesions and preoperative continence status are positive predictors for post-TCR continence. While pre-and post-TCR urodynamics do not predict continence status, their utility in preoperative work-up, monitoring for retethering, and long-term urologic follow-up requires further examination.
Neurosurgical Focus, 2012
An intact, fully functional spine is the result of a complex sequence of embryological events involving both nervous and musculoskeletal system precursors. Deviations from this highly ordered system can result in congenital abnormalities ranging from clinically insignificant cosmetic changes to CNS malformations that are incompatible with life. Closure of the neural tube, which is believed to be the embryological event gone awry in these cases, is complete by just 28 days' gestation, often before pregnancy is detected. Although progress has been made to help prevent neural tube defects in the children of those attempting to conceive, these congenital deformities unfortunately continue to affect a startling number of infants worldwide each year. Furthermore, the precise mechanisms governing closure of the neural tube and how they might be interrupted remain elusive. What is known is that there are a large number of individuals who must deal with congenital spine dysraphism and the clinical sequelae on a daily basis. Bladder and urinary dysfunction are frequently encountered, and urological care is a critical, often neglected, component in the lifelong multidisciplinary approach to treatment. Although many treatment strategies have been devised, a need remains for evidence-based interventions, analysis of quality of life, and preemptive education of both caregivers and patients as they grow older. Pediatric neurosurgeons in particular have the unique opportunity to address these issues, often in the first few days of life and throughout pre-and postoperative evaluation. With proper management instituted at birth, many patients could potentially delay or avoid the potential urological complications resulting from congenital neurogenic bladder.
Urodynamic outcomes of detethering in children: experience with 46 pediatric patients
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2016
Tethered cord syndrome (TCS) manifests with neurological and urological complaints. Surgical detethering is the main treatment for TCS. Children with urological symptoms are required objective pre- and postoperative evaluations in order to predict urological outcome. The aims of this study are to investigate the effects of detethering procedure on the urodynamic tests and to determine the relationship between the changes of urodynamic tests and the patients' age and gender. The data of urodynamic tests in 46 pediatric patients, who underwent surgery for TCS, were retrospectively evaluated. Bladder capacity, post-voiding residual urine volume, maximum intravesical pressure, and bladder compliance of each patient were measured in preoperative period and at the third month after surgery. These parameters were statistically compared, and the correlations of these parameters with age, gender, and etiology of the TCS were also investigated. Bladder capacity and post-voiding residual u...
The effects of detethering on the urodynamics profile in children with a tethered cord.
ETHERING of the spinal cord is a pathological fixation of the cord in the spinal column. It can be caused by congenital defects involving neurulation processes, such as meningocele, lipomeningocele, split cord malformation, and dermal sinus tract, or the tail bud canalization processes, such as a thick terminal filum, filar lipoma, and terminal myelocystocele. 12 In 3 to 15% of patients who undergo surgical repair of spina bifida, tethering occurs as a result of postoperative scarring. 8,15,16 A tethered spinal cord can cause urinary tract deterioration, producing symptoms of urinary incontinence, impaired bladder compliance, and/ or detrusor hyperreflexia. It can also lead to other pathological conditions, such as back pain, gait deterioration, leg weakness, hip and knee contractures, scoliosis, sensory loss, changes in bowel function, and orthopedic foot deformities. Authors of previous studies have evaluated the effects of detethering on bladder function-although some have found improvement, others have not. Because urodynamic testing has proven to be useful in the assessment of urological impairment associated with a tethered cord (with sensitivity approaching 100% for diagnoses such as sphincter dyssynergia 18 ), we sought in this study to characterize the effects of early detethering on the postoperative urodynamic profile in children.
Spinal dysraphism and neurogenic bladder: Still a relevant topic
The Journal of Medical Research, 2017
Background: The spinal dysraphism (SD) is a common disease in children. It remains a current topic because of its bladder and sphincter disorders' (BSD) impact involving the vital and functional prognosis. Myelomeningocele is the most severe form of spina bifida (SB). Objective: To highlight the BSD in SD patients and their features. Materials and methods: We conducted a retrospective study including patients followed in our Physical and Rehabilitation Medicine (PRM) Department and having BSD associated with SD. We collected epidemiological and clinical characteristics, such as neurologic level, orthopedic deformities, assistive device use, and level of ambulation in addition to biological, radiological and urodynamic features, care and follow-up. Results: Fifty patients, 30 girls and 20 boys, average age 10.33 ±1.28 years, mean length of follow-up 5.8 years. The most common type of SD was myelomeningocele, 30 had an independent ambulation. Urinary symptoms were dominated by urinary incontinence. The serum creatinine was disrupted in 18 cases including one with end-stage renal disease performing hemodialysis. Urine tests showed a urinary tract infection in 35 patients. The radiographic abnormalities were hypertonic bladder in most cases. Urodynamic exploration objectified an overactive bladder in most cases. The preferential micturition way was intermittent catheterization associated, in most cases, with anticholinergic treatment and in one case the intra-detrusor botulinum toxin. Conclusion: The BSD in children with SD remain a major issue requiring early and multidisciplinary care to preserve the integrity of the upper urinary tract and to improve the quality of life.
Acta Neurochirurgica, 2008
Background. The aim was to asses the clinical profile and urodynamic findings and the outcome of surgery in children with spinal dysraphism. Method. Twenty five children with spinal dysraphism who were treated at our institute between January 2005 and June 2006 were studied prospectively. There were 10 with an open spina bifida and 15 closed. The clinical profile of bladder dysfunction was assessed and urodynamic evaluation done pre-operatively in each child. An ultrasound study of the kidneys was also done to assess for hydrouretero-nephrois. All underwent surgery for their primary and associated malformations. Post-operatively, re-evaluation of bladder dysfunction and urodynamic parameters was performed at 6-8 months. Results. Before operation there was a history indicating that the bladder was involved in 14 of the 25 children. Six of the 10 cases with an open spina bifida showed clinical involvement of the bladder as compared to 8 of 15 with a closed pattern. Urodynamic studies showed evidence of bladder dysfunction in 19 children. Of 10 with a meningomyelocele, there were abnormal urodynamics in 9 as compared to 10 of 15 with closed dysraphism. Follow up urodynamic studies showed improvement in 9 of 20 children 3 of 7 with a meningomyelocele and 6 of 13 with closed dysraphism. Conclusion. Children with open spina bifida, as compared to closed dysraphism, tend to have more bladder dysfunction as exemplified on clinical history and urodynamic assessment. A pre-operative urodynamic study helps to identify severity of bladder dysfunction which is clinically overt cases and also identifies subtle bladder dysfunction in clinically silent cases. Evaluation after operation tends to shows better outcome in children with closed dysraphism. The study also identifies deterioration in some patients with seemingly clinical improvement.
Long-term urological outcomes in paediatric spinal cord injury
Spinal Cord, 2006
Study design: Retrospective review. Objective: This retrospective review observes the evolution of bladder management by time and reports adult urological outcomes and complications in paediatric onset spinal cord injury (SCI). Setting: Spinal Injuries Unit RNOH Stanmore. Method: In total, 10 traumatic SCI patients with mean age at injury of 13.6 years underwent treatment, for a mean period of 13.1 years. Characteristics of injury were noted. Two diagnostic subgroups, neurogenic detrusor overactivity (NDO), and acontractile detrusor were made. Complications, treatment changes, operative procedures with follow-up were noted. Results: In group 1 (6/10 patients) with NDO, five had DSD. Initial bladder management was reflex/urge voiding (n ¼ 4), suprapubic catheterisation (SPC), (n ¼ 1) and self-intermittent catheterisation (SIC), (n ¼ 1). Two patients had multiple upper tract complications with decreased renal function, two recurrent symptomatic urinary infections and one; bladder calculus. In total, 12 operative procedures were performed to treat complications and change bladder management to, SIC þ oxybutynin (n ¼ 3), ileal conduit (n ¼ 1), sacral anterior root stimulator implant (SARSI), (n ¼ 1), voiding on urge (n ¼ 1). In group 2 (4/10 patients) with a-contractile detrusor two had low compliance. Initial bladder management was SIC (n ¼ 3) and voiding on urge/straining (n ¼ 1). Two patients converted from SIC to permanent catheter drainage and reported complications. Incidental kidney stone was diagnosed in one. A total of four interventions were carried out with final management of SIC (n ¼ 2), voiding on urge/ straining (n ¼ 1) and Mitrofanoff þ ileocystoplasty (n ¼ 1). Conclusion: Bladder management in paediatric SCI is dependent on neurological level and type of injury; it changes with growth and is affected by changes in bladder management.
Occult spinal dysraphism: Neurogenic voiding dysfunction and Long-term urologic follow-up
Journal of Pediatric Surgery, 1998
From 1976 to 1994, we followed 55 children with occult spinal dysraphism (OSD). The average age at diagnosis was 4.5 years (range: 24 days-21 years). In 13 cases the OSD was associated with anorectal anomalies. Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OSD. At diagnosis, all children underwent complete neurourologic and urodynamic evaluation. Nine required early neurosurgical correction, before 3 years of age. During follow-up, intermittent clean catheterization was started in all patients. Vesicoureteral reflux was present or developed in 17 patients: 15 underwent endoscopic procedures and 2 required bladder augmentation because of upper-tract and renal-function deterioration. Endoscopic treatment for urinary incontinence was performed in 3 children. At long-term follow-up (6 to 18 years), socially acceptable continence was achieved in 78% of the children; renal failure occurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children with OSD with or without neurosurgery.