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At least 199 records · Page 11Linked to original sources
PubMed1995

Augmentation duracystoplasty in neurogenic bladder dysfunction.

BACKGROUND: Augmentation cystoplasty is the treatment of choice for patients with neurogenic bladder dysfunction in cases that are unresponsive to other medical treatment. Although intestinal segments as bladder substitutes are preferred over the other alternatives at present, they are not ideal bladder replacements due to several potential hazards. The purpose of this study was to determine whether or not augmentation duracystoplasty can be an alternative to augmentation enterocystoplasties. METHODS: Ten patients with neurogenic bladder dysfunction unresponsive to conservative measures, underwent augmentation duracystoplasty by using the modified Bramble-Clam technique. The follow-up period was T-28 months. RESULTS: At present, seven of 10 patients are completely continent for with clean intermittent catheterization. The remaining three patients required oral oxybutinin therapy, postoperatively, to achieve continence although lower dosages than those required in the preoperative period. We did not observe any serious pre- or postoperative complications. CONCLUSIONS: Based on these preliminary findings we think that duracystoplasty can be considered as a treatment alternative for hyperreflexic and/or low compliant neurogenic bladders.

Adolescent↗
PubMed2006

Management of the neurogenic bladder in the female patient.

Management of the female patient with neurogenic bladder requires special considerations that are not seen with many male neurogenic bladder patients. Because of the unique challenges that certain women present, a disproportionate number of women end up with an indwelling catheter or continuously leak urine into a diaper. Other options for bladder management include intermittent catheterization and reconstruction, which, when used appropriately, can lead to significant improvements in urinary continence, quality of life, and patient independence. This article reviews the various options available today as well as several potential therapies that may be available in the future.

Catheters, Indwelling↗
PubMed2003

Structural basis of neurogenic bladder dysfunction. III. Intrinsic detrusor innervation.

PURPOSE: We studied the ultrastructure of intrinsic detrusor innervation in long-standing neurogenic bladder dysfunction in the human. MATERIALS AND METHODS: Endoscopic or open detrusor biopsies were obtained from 15 female and 31 male patients 7 to 96 years old who had hyperreflexic neurogenic bladder dysfunction for less than 1 to 43 years. Of the patients 9 had meningomyelocele, 25 had spinal cord injury and 12 had a brain disorder. Changes in intrinsic detrusor nerves were evaluated by electron microscopy qualitatively and quantitatively according to predefined criteria. RESULTS: Axonal degeneration was observed in 44 of the 45 biopsies with discernible intrinsic nerves. Structurally normal axons were 5(1/2) or 4 times more common in brain disorder than meningomyelocele or spinal cord injury group biopsies (median 33%, 6%, 8%, respectively). Axonal regeneration, not encountered in nonneuropathic dysfunctional detrusors, was observed in restricted distribution in most biopsies (76%) and was independent of the duration of neurogenic bladder dysfunction. Axon sprouts were observed in 17 biopsies (38%), and copeptidergic axons formed 20% (median per biopsy) of discernible axon profiles in contrast to less than 1% in normal detrusor. Activated Schwann cells were observed in all but 1 biopsy. The axonal changes were not associated with the level or degree of spinal cord lesion in patients with meningomyelocele or spinal cord injury. CONCLUSIONS: Combined degeneration and regeneration is the characteristic change in intrinsic nerves of detrusor in upper motoneuron neurogenic bladder dysfunction. The observed changes offer the possibility of clinically recognizing neuropathic contribution to a dysfunctional detrusor, as well as the potential to distinguish its spinal versus supraspinal etiology.

Adolescent↗
PubMed2005

E. coli virulence factors in children with neurogenic bladder associated with bacteriuria.

The value of E. coli virulence factors in patients with neurogenic bladder has not been established. The aim of this study is to correlate E. coli virulence factors with asymptomatic and symptomatic UTI in children with neurogenic bladder. Fifty E. coli strains, which were collected in sequence, underwent analysis in relation to: the association to pyuria, serotype (O:H), the presence of genes and expression of fimbriae P, type 1, S and hemagglutinin Dr, the presence of the gene and production of hemolysins and cytotoxins (CNF1). We also analyzed the cell adherence capability and pattern and presence of usp (uropathogenic-specific protein). Pyuria was present in most of the positive urine cultures, with 86% AB and 97% UTI. Low rates of uropathogenic strains were observed in the two groups, with 18% AB and 21% UTI. Type 1 fimbria predominated in 44% of the E. coli strains. Of the bacteria studied, 30% (15 strains) exhibited papG genotypes (11 class II and 4 class III). Of these, 12/15 patients presented AB. Production of hemolysins was detected in 38% of the strains (16 AB and 3 UTI) and usp in only 18% of the strains, with 8 AB and 1 UTI. Adherence tests demonstrated the adhesive capacity in all samples analyzed. Neither group (AB or symptomatic UTI) presented a statistically significant difference in relation to the virulence factors studied. E. coli clones that caused symptomatic UTI in children with neurogenic bladder expressed few virulence factors, with no statistically significant difference in comparison to the AB group.

Bacterial Adhesion↗
PubMedDate not supplied

[Current overview of the treatment of postmyelomeningocele neurogenic bladder].

OBJECTIVE: The present article reviews the current therapeutic modalities for neurogenic bladder secondary to myelomeningocele. METHODS: The procedures utilized in the treatment of neurogenic bladder are described. The results achieved by the artificial urinary sphincter in 43 patients are presented. RESULTS: Most of the patients were 8 to 20 years of age at the time the artificial urinary sphincter was implanted. A complementary surgical procedure was required in 11 patients and 10 have been included in the program of intermittent catheterization. Few complications have been observed. CONCLUSION: The implantation of an artificial sphincter can enhance the quality of life of incontinent patients that meet the appropriate clinical and urodynamic criteria.

Adolescent↗
PubMed2005

Trigonoplasty to treat secondary vesicoureteral reflux in neurogenic bladders.

OBJECTIVES: The effectiveness of Gil-Vernet's trigonoplasty, with technical modifications, was studied in treating vesicoureteral reflux (VUR) in neurogenic bladders. METHODS: Modified Gil-Vernet's trigonoplasty, making the transmural ureters advance over the midline and cross each other in the trigone, was applied in patients with neurogenic bladder dysfunction and VUR, diagnosed by voiding cystourethrogram. Most of the patients were sufficiently followed up by cystourethrogram. RESULTS: 26 patients with neurogenic bladder dysfunction were diagnosed as having 43 refluxing units and underwent modified Gil-Vernet's trigonoplasty. Reflux was grade I in 5 units, grade II in 7, grade III in 5, grade IV in 18, and grade V in 8, with unilateral reflux in 9 patients and bilateral reflux in 17. Surgery was successful in 95.3% of 43 refluxing units. 22 patients were followed 3-6 months after the operation, and the cure rate was 90.9% (no reflux under voiding cystourethrogram). 18 patients were followed up for more than 2 years without recurrence of VUR. CONCLUSIONS: Modified Gil-Vernet's trigonoplasty might be a useful technique in the management of patients with VUR secondary to neurogenic bladder dysfunction.

Adolescent↗
PubMed2004

Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder dysfunction.

OBJECTIVES: To review our experience performing percutaneous nephrolithotomy (PNL) on patients with neurogenic bladder dysfunction with special attention paid to the risks of surgical complications and stone recurrence. Patients with neurogenic bladder dysfunction with or without urinary diversion are at increased risk of urolithiasis, surgical complications, and recurrent stone disease. METHODS: We retrospectively reviewed the 23 patients with neurogenic bladder dysfunction who underwent PNL at our institution. Neurologic lesions included spina bifida, traumatic spinal cord injury, exstrophy/epispadias, neonatal meningitis, stroke, and spine chondrosarcoma. Bladder management included ileal conduit (n = 8), intermittent catheterization (n = 7), indwelling catheter (n = 7), and ureterosigmoidostomy (n = 1). RESULTS: We performed 100 procedures on 47 renal units (17 bilateral, 7 with recurrent stones). Urinary tract infection/colonization was seen in 21 of 23 patients, most of whom had more than one organism. The stone-free rate was 96%. Six patients required three or more procedures, each had a complete staghorn calculus. In an average of 36 months of follow-up, 10 patients (46%) had recurrent stone disease requiring intervention, and 5 patients (23%) underwent repeat PNL. The stone composition analysis revealed mainly infection-related stones. CONCLUSIONS: PNL in patients with neurogenic voiding dysfunction is safe and effective, with outcomes comparable to that of patients without such lesions. The complication rate is small but statistically significant. It is important to obtain adequate urine cultures, because renal pelvis and bladder culture data may differ and affect the outcome. Risk factors for recurrent stone disease include a high spinal cord lesion, indwelling urinary catheter, and ureterosigmoidostomy.

Adolescent↗
PubMed1991

[Electrophysiologic diagnosis of neurogenic bladder in children with myelodysplasia].

Ninety-seven children with neurogenic bladder and myelodysplasia were subjected to complex examination. The somatic innervation of the sphincter urethrae externus and sphincter ani muscles was appraised by the method of sacral guided reactions by a CT-01 electromyograph and by an original method consisting in registration of the reflex response of the named anatomical structures according to the fluctuations of the intraurethral and intraanal pressure. It was established that maintained, partly disturbed, and absolutely absent somatic innervation of the sphincters of the bladder and rectum is encountered in patients with myelodysplasia. The more the innervation of the sphincters disturbed is, the more the urinary bladder is excluded from the "accumulation-evacuation" urodynamic cycle and the lesser the probability of disorders of urodynamics of the upper urinary tract is, and vice versa. The obtained information is important in choosing the therapeutic tactics for patients with a neurogenic bladder.

Anal Canal↗
PubMed1982

Observations on the internal sphincter mechanism during the filling phase in children with hyperactive neurogenic bladder.

The internal sphincter mechanism in the urinary bladder was investigated in three groups of children. Two groups had neurogenic bladder, one of them with and one without detrusor hyperactivity. The third group had no myelodysplasia and normal detrusor activity in the filling phase. In this group the sphincter contractions were sustained at high pressure level, with superimposed waves of substantial amplitude. Myelodysplasia of segments below L3 was associated with hyperactivity of the detrusor. The general sphincter pattern in this condition was the same as in the normal group, but the behavior of the sphincter was not synchronized with the pressure fluctuations in the bladder. In the children with low thoracic or high lumbar level of lesion ther was no detrusor hyperactivity. Their sphincter mechanism could be characterized as passive, with low mean pressure and low amplitude of superimposed waves. When detrusor hyperactivity is present, it seems to be the main factor in leakage from neurogenic bladder. In the absence of detrusor hyperactivity in neurogenic bladder, passivity of the internal urethral sphincter due to dissociation from the spinal centers is proposed as the explanation of incontinence.

Adolescent↗
PubMed1992

Management of urinary incontinence in neurogenic bladder.

The treatment of children with urinary incontinence caused by a neurogenic bladder presents a challenge to the paediatric urologist. Between 1965 and 1989, 527 patients with neurogenic bladder were treated and followed-up in the Department of Paediatric Urology of Debrousse Hospital. Of these, 46 were submitted to continent cystostomy, 39 to urinary artificial sphincter and 177 to clean intermittent catheterization (CIC). This last treatment is of paramount importance in girls and can be associated with complementary procedures if cervico-urethral resistance and/or bladder compliance are poor. Urethral lengthening (Kropp's procedure) in combination with CIC represents a major means of providing dryness in girls. Our technique of urethral lengthening is detailed and the place of CIC among other incontinence treatment is discussed.

Child↗
PubMed1993

Frequency and correlates of bacteriuria among children with neurogenic bladder.

Bacteriuria is a common clinical problem among children with neurogenic bladder due to meningomyelocele or traumatic spinal cord injury. To determine the frequency of bacteriuria among affected children at our institution, we obtained 257 urine specimens from 105 children being seen as outpatients for routine care over a 2-year study period. Specimens were obtained via catheterization. Almost half of these specimens (110/257 or 43%) yielded positive results when tested for urinary pathogens. To assess whether any characteristics of these children were related to the likelihood of bacteriuria, we analyzed further a subgroup of 46 children with normal renal ultrasonography from whom two to five specimens were obtained. There were no statistically significant associations between the likelihood of bacteriuria and the following characteristics: age, gender, socioeconomic status, level of spinal cord lesion, voiding technique, and use of prophylactic antibiotics. Children with neurogenic bladder are at high risk for bacteriuria. The pathogenesis of this bacteriuria, its part in deterioration of the urinary tract, and the possible means of its prevention in this special population all deserve further study.

Bacteriuria↗
PubMed2003

[Neurogenic bladder: report of 73 cases].

The authors report their experience of neurogenic bladder about 73 cases during 16 years. The analysis of the data permits to affirm that the neurogenic bladder remained a rare pathology, that their aetiologies is acquired in 87.6% of the cases with a predominance of spinal cord traumatisms, which explains the predominance of the pathology among the young subject of masculine sex (middle age of 32 years, sex-ratio is 2.5). The clinical signs are represented by urinary incontinence that constitutes the main motive of consultation, followed by obstructive signs and frequent miction associated to urge miction. The explorations put in evidence an important rate of complications because of the diagnostic delay. The therapeutic management aims to assure a most complete draining of the bladder to low pressure, to assure the continence or at least to manage the incontinence while assuring the comfort and the patient's autonomy.

Adolescent↗
PubMed1988

[The management of vesicoureteral reflux with neurogenic bladder due to spina bifida].

Thirteen cases (20 ureters) of vesicoureteral reflux (VUR) associated with neurogenic bladder, treated with anti-reflux operation are reviewed. Twelve of the 13 cases had meningomyelocele and 1 had spina bifida occulta as an underlying disease. The type of neurogenic bladder was hypoactive detrusor-active sphincter in 11 patients and hypoactive detrusor-hypoactive sphincter in 2 patients. They were treated with an anti-reflux operation, 2 ureters by Politano-Leadbetter method and 18 ureters by Cohen method. The results were successful (success rate 85.0%). Therefore, we concluded that in neurogenic bladder patients especially with the hypoactive detrusor-active sphincter, the cause of their renal deterioration is mostly VUR. Thus we should examine such patients for VUR. On the other hand, when the renal deterioration of VUR patients cannot be improved by conservative treatment for example clean intermittent catheterization or indwelling catheter, we should perform an anti-reflux operation.

Adolescent↗
PubMed1993

Screening for urinary tract infection in children with neurogenic bladders.

Urinary tract infections (UTIs) are a frequent and potentially disabling problem for children with neurogenic bladders. Frequent monitoring for UTIs using bacterial culture is expensive and troublesome; thus an inexpensive, dependable screening method is desirable. Three hundred and twenty-nine urine specimens were obtained from 141 children with neurogenic bladders, 86% of whom had meningomyelocele. During the 11-month study period, 43% of the children had at least one positive culture (> or = 100,000 CFU/ml). The results of bacterial culture were compared with the occurrence of signs and symptoms, the presence of reflux and the results of a dipstick test for nitrite and leukocyte esterase. Analysis of the data revealed that (1) UTIs were significantly more common in children with reflux; (2) the presence of signs and symptoms was neither sensitive nor specific (positive predictive value (PPV) = 0.44, negative predictive value (NPV) = 0.84); (3) urinalysis was an unreliable screening tool (PPV = 0.63, NPV = 0.73); and (4) the combination of nitrite and leukocyte esterase was more sensitive and specific than either by itself (combined PPV = 0.69, NPV = 0.88). Children with neurogenic bladders who have reflux or have signs and symptoms should continue regular bacterial cultures, whereas others can be screened dependably using the combined leukocyte esterase and nitrite test.

Adolescent↗
PubMed1976

Bethanechol chloride in neurogenic bladder dysfunction.

Representative case summaries of patients with different types of neurogenic bladder diagnosed by combined cystometric-perineal electromyography and treated with bethanechol (Urecholine) are presented. Determination of the activity of the periurethral striated muscle in relation to bladder dysfunction is extremely important in the selection of patients for bethanechol therapy. In the absence of structural obstruction, bethanechol can be used in patients with (1) the early phase of coordinated reflex neurogenic bladder and sphincter when there is incomplete bladder emptying due to feeble or unsustained detrusor contractions, (2) recovery phase of spinal shock when the periurethral striated muscle has recovered and is under voluntary control, (3) incomplete motor paralytic bladder with coordinated sphincter, and (4) sensory paralytic bladder with decompensation. The bethanechol regimen will vary in accordance with the type of bladder being treated.

Achondroplasia↗