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PubMed1977

Intermittent catheterisation in congenital neurogenic bladder: a preliminary report.

53 children with congenital neurogenic bladders are currently managed on intermittent catheterisation. The problems of continence, urinary tract infection and upper tract deterioration have to date been controlled reasonably successfully and the need for urinary diversion appears to have been obviated. Complications have been negligible and parents and patients alike prefer this method to the Crédé manoeuvre.

Adolescent↗
PubMed1981

Conservative management of vesicoureteric reflux in the congenital neurogenic bladder.

A series of 31 patients with congenital neurogenic bladder in which vesicoureteric reflux was managed conservatively by methods designed to improve voiding function is reported. Satisfactory results, in terms of the appearance of the upper urinary tracts on IVU, were obtained by indwelling urethral catheter, or by alpha-adrenergic blockade, internal urethrotomy or external urethral sphincterotomy; in the case of the last 3 procedures this was accompanied by diminution or resolution of vesicoureteric reflux. Less satisfactory results were obtained by intermittent self catheterisation and in patients managed in this way a case exists for ureteric reimplantation.

Adolescent↗
PubMed1988

Fate of nonneurogenic neurogenic bladder--end-stage renal failure.

The nonneurogenic neurogenic bladder syndrome which actually comprises a large spectrum of clinical radiological, psychological and behavioral disorders, is manifested by bladder-sphincter incoordination and constitutes a very complex problem of overall management. The condition refers to infravesical functional obstruction in children in whom no anatomic or neurological defect is demonstrated. Although the etiologic bases are often unclear, successful management of urinary infection and reflux and prevention of upper tract deterioration are achievable by multidisciplinary conservative measures, sometimes reinforced by ureteric reimplantation. End-stage renal failure due to this syndrome is a rare complication. The presented case demonstrates well all the clinical features of this syndrome, which unfortunately ended in hemodialysis.

Adolescent↗
PubMed1989

[Urodynamic and electrophysiologic studies in evaluating congenital neurogenic bladder].

We investigated 50 patients with a congenital neurogenic bladder secondary to myelomeningocele (38), sacral agenesis (5) and occult spinal dysraphism (7). There were 25 males and 25 females, aged from 1 month to 29 years (mean age at the time of evaluation was 9.2 years). Pressure-Flow-EMG study was obtained in every instance. In addition, 25 patients underwent electrophysiological testing (sacral reflex arc testing and somatosensory evoked potentials from the pudendal nerve). The patients were then classified according to the urodynamic and electrophysiological results. We allocated the patients into a "functional" classification as recommended by Van Gool. This classification is useful in the selection of proper therapy, and in the definition of the risks of upper tracts deterioration.

Adolescent↗
PubMed1996

[Continent urinary diversion in neurogenic bladders].

Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.

Adolescent↗
PubMedDate not supplied

[Combination of oxybutynin chloride (Ditropan) with intermittent catheterization in the treatment of neurogenic bladder in childhood: results on continence].

Nowadays Intermittent Catheterization (I.C.) is considered the treatment of choice in patients with neurogenic bladder dysfunction, because of its easy handling and good results. Renal function preservation, urinary tract infections prevention and continence can be achieved by this method. In particular, I.C. per sè improves continence quality in many cases, but, in the majority of them the best results can be obtained by drug therapy addition, having in mind a more direct action on to detrusor compliance and/or bladder neck tone. Oxybutynin Chloride (Ditropan)(-) is the first choice drug, even in childhood, in cases of neurogenic bladder dysfunction, for its anticholinergic, antispastic and analgesic properties. From 1978, 48 children with neurogenic bladder have been treated by I.C. Out of them, 27 have had drug therapy (Oxybutynin Chloride-Ditropan) in addition to I.C., according to indications of clinical, radiologic and urodynamics findings. Results on continence are discussed.

Adolescent↗
PubMed2002

Is ureteral reimplantation necessary during augmentation cystoplasty in patients with neurogenic bladder and vesicoureteral reflux?

PURPOSE: We assessed the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder. MATERIALS AND METHODS: Since May 1992, 112 male and 18 female patients with neurogenic bladder have undergone augmentation cystoplasty with a generous detubularized segment of bowel and no effort to correct existing reflux. Patients were treated conservatively at the beginning but the response was unsatisfactory. All patients had various degrees of vesicoureteral reflux (197 refluxing units). Mean age at operation was 21.6 years (range 1.5 to 57). Preoperatively assessment included urinalysis, urine culture, kidney function tests, voiding cystourethrography, urodynamic evaluation, ultrasonography or excretory urography and cystoscopy when indicated. The status of vesicoureteral reflux, renal hydronephrosis and clinical pyelonephritis were studied during an average followup of 44.5 months. RESULTS: Of the 130 patients 111 (85.4%) no longer had reflux, 14 (10.8%) had improvement, 4 (3%) had no change and 1 (0.8%) had worsening reflux. All refluxing units with grades I to III, 105 of 120 with grade IV (87.5%) and 8 of 13 with grade V (61.5%) showed complete cessation of reflux. Renal hydronephrosis improved in 127 renal units (97.7%). In 8 individuals (6.2%) without reflux after cystoplasty episodes of clinical pyelonephritis occurred. CONCLUSIONS: Augmentation cystoplasty without ureteral reimplantation is effective and adequate treatment for high pressure, noncompliant neurogenic bladder when conservative management fails.

Adolescent↗
PubMed1999

Management of neurogenic bladder dysfunction with incontinent ileovesicostomy.

OBJECTIVES: Incontinent ileovesicostomy is an alternative form of urinary management applied to patients with neurogenic vesical dysfunction who are either unable or unwilling to perform clean intermittent self-catheterization or assisted catheterization. We review our operative results, urodynamic data, and complications observed in patients who underwent creation of incontinent ileovesicostomy at our institution. METHODS: Thirteen patients (mean age 43.2 years) with neurogenic bladder dysfunction underwent an incontinent ileovesicostomy between 1994 and 1998. The etiologies of the neurogenic bladder dysfunction were spinal cord injury in 8 patients, multiple sclerosis in 4 patients, and tuberculous meningitis in 1 patient. The preoperative data, surgical records, urodynamic findings, and postoperative complications were assessed. RESULTS: All patients experienced complications of their pretreatment bladder management. The mean operating room time was 242 minutes (range 170 to 395), including 14 additional procedures in 1 1 patients. The mean estimated blood loss was 403.8 mL (range 50 to 2000). No patient required blood transfusion. There were no intraoperative complications. Only 1 patient required reoperation for stomal revision. One patient had a ureteral stone 2 years after surgery; 1 patient has continued to have urinary tract infections despite a negative workup. The mean follow-up was 23 months (range 6 to 57). The mean bladder leak point pressure through the stoma was 8.2 cm H2O. CONCLUSIONS: The incontinent ileovesicostomy is a useful technique in the treatment of patients with neurogenic bladder unable to perform clean intermittent catheterization. It provides patients with a low-pressure urinary conduit that empties readily without an in dwelling catheter.

Adult↗
PubMed1994

[Three cases of neurogenic bladder due to neuro-Beçhet disease].

We reported three cases of neurogenic bladder due to neuro-Beçhet disease. Case 1 (24-year-old male) and case 3 (54-year-old male) had complaint of urinary frequency and urinary incontinence. Case 2 (35-year-old male) had a complaint of urinary retention. Uro-dynamic study were performed repeatedly in each case. Two cases showed overative detrusor activity in storage phase and normal or hypo detrusor activity in voiding phase. One case (case 2) showed normal detrusor activity in storage phase and acontractile in voiding phase. All cases showed detrusor-sphincter dyssynergia (DSD). All cases were managed with clean intermittent catheterization. Six months later case 2 complained of urge incontinence. Repeated uro-dynamic study revealed that bladder function changed from normal detrusor to overactive detrusor in storage phase. These findings suggest that neurogenic bladder due to neuro-Beçhet disease is characterized uro-dynamical by overactive detrusor in storage phase and DSD in voiding phase.

Adult↗
PubMed1989

[Effects of long-term administration of oxybutynin hydrochloride (KL007) for the treatment of neurogenic bladder and unstable bladder].

The efficacy and safety of long-term administration of oxybutynin hydrochloride in patients with neurogenic bladder and unstable bladder, who complained of urinary frequency, urgency and incontinence, and whose bladder was proved to be uninhibited, reflex, and/or low compliant, were studied at the multi-center hospitals, and the following results were obtained. This study comprised 149 cases but 8 of them were excluded because of the incomplete protocol. Thus, 141 cases (104 neurogenic bladder patients, 33 unstable bladder patients and 4 others) were investigated. The daily dosage of Oxybutynin hydrochloride ranged from 1 to 18 mg, and averaged at 6.6 mg. Since a small daily dosage of 3 mg was administered in 32 cases to examine the minimum effective dosage of the drug, the low average dosage possibly resulted. The clinical optimal dosage seemed to be more than 6.6 mg. The average period of administration in all cases was 161.7 days (1-336 days), and the drug was discontinued in 46 cases (33.6%) on average 62.1 days (1-141 days). The rate of global improvement by this drug estimated at the time of completion was found to be 65.6% with excellent and good and 87.8% with excellent, good and fair. The efficacy of this drug was stable and not decreased during the long-term test period. As to the objective findings studied before, during and after the drug administration, cystometric bladder capacity was significantly increased both first desire to void and the total capacity. Voided volume and residual urine were also increased, but there was no change in the rate of residual urine. Side effects were observed in 37 (26.2%) of 141 cases, and mainly gastrointestinal signs such as dry mouth and constipation. Urological signs such as dysuria and urinary retention were experienced in 8 cases. Regarding the findings of laboratory tests, there were no abnormality except for small changes of some items in normal range. Six children who were younger than 15 years old were subjected to this study. The results of evaluation were similar to those obtained on adults and no side effects were observed. From these findings, oxybutynin hydrochloride is considered an effective and useful drug in patients suffering from neurogenic bladder and unstable bladder with over active bladder condition.

Adolescent↗
PubMed2004

Donald Munro Lecture 2003. Neurogenic bladder: past, present, and future.

The foundation of the management of neurogenic bladder can be attributed to a pioneer in spinal cord injury medicine. Dr. Donald Munro, a neurosurgeon, who also had experience in urologic surgery, established the first Spinal Cord Injury Service of 10 beds in the Boston City hospital in the 1930s. He later became adviser to the US Army and the Veterans Administration (VA). On his recommendation, paraplegic centers were created in US army hospitals and later in the VA hospitals from 1943 to 1945. This article reviews the evolution of the management of neurogenic bladder in patients with spinal cord injuries from the past century to the present. The role of urodynamics in defining neurologic lesions is critical to the appropriate management of the voiding dysfunction. Key advances, such as the diagnosis of detrusor sphincter dyssynergia (DSD), recognition of its association with autonomic dysreflexia, and its definitive management, have been emphasized. The role of transrectal linear array sonography using a rectal probe was found useful for defining bladder outlet dysfunction during urodynamics. It also helped to recognize secondary bladder neck obstruction and diagnose false passages in the urethra. Clean technique intermittent catheterization (IC) was evaluated and recommended. In about 28% patients with DSD that led to secondary bladder neck obstruction, a consequence of IC was reported. Transurethral laser sphincterotomy (TURS) was first reported by me in 1991, and later, durable 7-year follow-up results were reported in 78% of the first 99 patients. We reported a surgical technique to lengthen the penis. We also reported the long-term success with semirigid implants in 92% of patients with SCI. This technique helped maintain external condom drainage on a small phallus and improved the sex life of patients, as well as their quality of life. The author's pertinent areas of interest in the past one-half century were aimed at recognizing specific urologic problems associated with neurologic impairment. Management was aimed at preventive care, early recognition, and timely management to reduce secondary complications and enhance quality of life.

Humans↗
PubMed1980

Hereditary spastic paraplegia with neurogenic bladder disturbances and syndactylia.

The present paper reports a family settled in the northern part of Norway, with a hereditary neurological disorder consisting clinically of spastic paraplegia associated with neurogenic bladder disturbances and syndactylia. Nine out of 22 members in three generations exhibit these clinical features. The bladder disturbances, being incomplete supranuclear bladder paresis (uninhibited neurogenic bladder), were the main complaint and occurred at an early stage of the disease. The family probably represents an unusual form of hereditary spastic paraplegia (HSP). The mode of inheritance is considered to be autosomal dominant.

Adolescent↗
PubMed1984

A 22-year followup of ileal conduits in children with a neurogenic bladder.

Previously, the ileal conduit had been used in children for diversion of urine from the neurogenic bladder to prevent deterioration of the upper urinary tracts and to manage urinary incontinence. Long-term results after ileal conduits in children have revealed upper tract deterioration and a high complication rate. The complications and renal deterioration rates in 139 children with ileal conduits followed up to 22 years were evaluated. Of 224 complications 114 required surgical correction. Upper urinary tract deterioration occurred in 16.5 per cent of 50 children followed for 10 or more years (mean 13.3 years). The ileal conduit has been replaced by clean intermittent catheterization, ureteral reimplantation for reflux, the artificial sphincter and undiversion in the management of neurogenic bladders in children. Long-term followup will be necessary to compare the results of these procedures to the known long-term results of the ileal conduit to determine the appropriate role of the ileal conduit in the management of children with neurogenic bladders.

Adolescent↗
PubMed2007

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat.

Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.

Animals↗
PubMed1997

Diagnostic value of natural fill cystometry in neurogenic bladder in children.

OBJECTIVE: Investigation of the diagnostic value of natural fill cystometry (NFC) in children with neurogenic bladder in comparison to conventional videocystometry (CVC). METHODS: We investigated 20 children (aged 6-11; 15 girls and 5 boys) with the following diagnoses: 6 myelomeningocele, 2 tethered cord syndrome, 1 syringomyelia, 1 Vater syndrome, 1 suprasacral spinal cord injury, 9 suspected neurogenic bladder. We carried out a NFC after completing standard diagnostic including a slow-filling CVC. RESULTS: All investigations were completed successfully. The investigation lasted 6-20.5 h (mean 11:15 h). We registered phases of sleep, waking consciousness and micturition. CVC findings were confirmed in 45%: normal bladder function was confirmed in 2 patients (10%), bladder hyperactivity was confirmed in 7 patients (35%). In 55% we obtained different findings on NFC in comparison to the slow-filling CVC: bladder hyperactivity was not confirmed in 2 (10%), detection of bladder hyperactivity was found in 4 children (20%) with normal bladder function on CVC, detection of bladder hyperactivity on NFC was found in 5 children (25%) with low-compliance bladder on CVC. In 45% of all children, NFC detected new findings compared with CVC diagnoses. In 10%, possible artifacts (e.g. due to catheterization) of CVC were recognized. CVC findings were confirmed in 45%. CONCLUSION: These results are preliminary but they suggest that this is a new diagnostic method for improving the diagnostic standard in the childhood neurogenic bladder.

Child↗
PubMed1988

[10 years' experience with intermittent catheterization in neurogenic bladder in children and adolescents: study of 165 cases].

Intermittent clean catheterization has been proposed in 1975 for the treatment of neurogenic bladder in children and teen-agers. We report results in 165 patients with neurogenic bladder (111 girls, 54 boys) from 1976 to 1986; 9 patients were lost for follow-up. Myelomeningocele was the cause of the neurogenic bladder in 132 cases. The effects on continence, upper-tract and urinary infection are studied. These data show that such a method is simple, harmless and effective for the protection of the upper urinary tract and for the control of urinary incontinence.

Adolescent↗
PubMed2001

Neurogenic bladder in Lambert-Eaton myasthenic syndrome and its response to 3,4-diaminopyridine.

Autonomic dysfunction, as well as neuromuscular involvement, is a common manifestation of Lambert-Eaton myasthenic syndrome (LEMS). Dry mouth and impotence have been described as typical features of autonomic dysfunction, but neurogenic bladder is infrequent or subclinical in LEMS. We report a patient with neurogenic bladder secondary to LEMS whose condition responded to 3,4-diaminopyridine (3,4-DAP). In this patient's serum, results of repeated measurement with P/Q-type VGCC antibodies proved positive, but not with N-type VGCC and synaptotagmin antibodies. A review of the literature turned up a few patients with voiding dysfunction related to LEMS, but no urodynamic studies were done on these patients. Ours is the first case in which 3,4-DAP was efficacious in treating LEMS and neurogenic bladder. Responses of 3,4-DAP in urodynamic studies suggest that in this LEMS patient neurogenic bladder was caused by defective neurotransmission both in the autonomic detrusor and skeletal abdominal muscles.

4-Aminopyridine↗