The role of occult spinal malformation and upper urinary tract deterioration in children with intractable voiding dysfunction (original) (raw)
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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.
Journal of Pediatric Urology, 2012
Objective: The role of magnetic resonance imaging (MRI) in detecting occult spinal dysraphism (OSD) in children with voiding dysfunction and a normal neurological examination is still under debate. The aim of this study was to assess the correlation of sacral skin lesions with OSD detected on MRI, in a population of children with resistant lower urinary tract symptoms (LUTS). Patients and methods: A total of 114 children over 5 years of age with urinary tract infection (UTI) and/or LUTS and normal neurological examination were enrolled. All children underwent sacral neurological examination, urine analysis and cultures, renal/bladder ultrasound, voiding cystourethrogram and urodynamic examination. After a treatment period of 6 months, the patients were re-evaluated and spinal MRI was performed in 61 with ongoing LUTS or UTI. Results: Nineteen of 61 children (31%) had cutaneous stigmas. MRI detected spinal abnormality in 2/42 children with a normal sacral examination in comparison to 7/19 children with an abnormal sacral finding (Chi-squared test, P < 0.005). The sensitivity and specificity of an abnormal sacral finding in predicting MRI abnormality were 0.76 and 0.77, respectively. Urodynamic parameters did not predict an abnormal spinal MRI. Conclusions: Abnormal sacral findings, but not urodynamic studies, are strong predictors of OSD. A normal sacral examination does not rule out OSD.
Diagnostic value of ultrasonography in spinal abnormalities among children with neurogenic bladder
Electronic Physician
Background: Nowadays, magnetic resonance imaging (MRI) is the gold standard for evaluation and diagnosis of spinal cord abnormalities, which are considered among the leading causes of neurogenic bladder; however, MRI is a costly imaging method and is not available at all health centers. Sporadic studies have shown the alignment of MRI with ultrasonography results in diagnosis of spinal abnormalities; although none of these studies has expressed the diagnostic value of ultrasonography. Objective: The aim of this study was to evaluate the diagnostic value of ultrasonography in detection of spinal abnormalities in children with neurogenic bladder. Methods: This is a cross-sectional study carried out from January 2014 to November 2015 on patients with neurogenic bladder referred to
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.
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.
Risk factors predicting upper urinary tract deterioration in children with spinal cord injury
Neurourology and Urodynamics, 2020
Study design: A prospective study. Objectives: To investigate the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). Setting: Beijing, China. Methods: We reviewed the medical records and UUT imaging studies of 112 patients, with a mean follow-up of 2 years. Variables evaluated for possible influence on UUTs included patient age, gender and educational background; injury level and completeness; bladder management method; and the presence of adverse outcomes such as recurrent urinary tract infections and bladder stones. Video urodynamic data were also reviewed. Total renal function was assessed by serum creatinine. UUT abnormalities were assessed by renal ultrasound or magnetic resonance imaging. Results: Lumbosacral spinal cord lesions likely contribute to UUT deterioration. UUT abnormalities were present in 23 patients (65.7%) in a spontaneous voiding group, 10 patients (20%) in a clean intermittent catheterization group, 15 patients (78.9%) in an indwelling urethral catheterization group and 7 patients (87.5%) in a suprapubic Foley catheterization group (Po0.001). When dividing bladder management method into two groups, catheter-free (spontaneous and intermittent voiding) and indwelling catheter (urethral and suprapubic catheterization), there was UUT dysfunction in 33 patients (38.3%) and 22 patients (81.5%), respectively (Po0.001). Conclusions: Lumbosacral SCI and chronic indwelling urethral and suprapubic catheterization were predictors of UUT deterioration.
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.
BJUI, 2013
Objectives • To describe the long-term upper (UUT) and lower urinary tract (LUT) outcomes in patients with closed spinal dysraphism (CSD). • CSD differs from open spinal dysraphism (OSD) by its long asymptomatic course and consequent later diagnosis. The outcome of UUT and LUT function in adults with CSD is relatively unknown. Conclusions • Few data are available on long-term urological outcomes in adult patients with CSD. • More extensive research on follow-up, including the functional status of the UUT, is recommended. • Based upon the little evidence available, we think lifelong follow-up (from birth into adulthood) of those with CSD and neurogenic bladder is advisable.