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PubMed1977

The phentolamine test in neurogenic bladder dysfunction.

In an attempt to improve the selection of patients with neurogenic bladder dysfunction likely to benefit from phenoxybenzamine therapy, the effect of intravenous phentolamine (Regitine) on the urinary flow rate was determined in normal and abnormal subjects. A nomogram relating mean flow rate to volume voided was constructed to aid in the interpretation of results. In 16 patients with neurogenic bladder dysfunction it was found that a response of more than 0.8 nomogram units indicates a likelihood of clinical improvement with phenoxybenzamine therapy. The clinical applications of this test are discussed.

Adult↗
PubMed1984

Management of the neurogenic bladder in 413 children.

During the last 10 years the management of the neurogenic bladder in children has changed from indwelling urethral catheterization or urinary diversion to intermittent catheterization or artificial sphincter implantation. Neurogenic bladder dysfunction in 413 children was caused by myelomeningocele in 323, traumatic paraplegia in 47, spastic quadriplegia in 11, sacral agenesis in 18 and spinal cord disease in 14. Management included indwelling urethral catheterization in 27 children, urinary diversion in 193, intermittent catheterization in 84, an artificial sphincter in 11 and undiversion in 6. No single treatment was completely effective or without significant complications.

Catheters, Indwelling↗
PubMed2005

Nocturnal bladder emptying: a simple technique for reversing urinary tract deterioration in children with neurogenic bladder.

PURPOSE: In this preliminary study we sought to determine the effect of instituting nocturnal bladder emptying (NBE) in children with neurogenic (NGB) or nonneurogenic neurogenic bladder (NNGNGB) in whom urinary tract deterioration developed despite optimal daytime clean intermittent catheterization (CIC) and urotropic medications. We hypothesize that a syndrome of nocturnal overdistention of the bladder (SNOB) can cause urinary tract deterioration through increased nighttime storage pressures manifested by recurrent urinary tract infection (UTI), worsening incontinence, hydronephrosis and/or decreasing bladder compliance and capacity, and may be reversed by NBE. MATERIALS AND METHODS: A total of 19 children with NGB (17) or NNGNGB (2) who displayed urinary tract deterioration while on CIC and urotropic medications were started on NBE. Of the patients 15 used a continuously draining nighttime catheter while 4 had scheduled awakenings during the night to perform CIC. The primary indications for NBE were recurrent symptomatic UTI in 5, new or progressive hydronephrosis in 7, and decreasing bladder capacity and compliance in 7. RESULTS: At a mean followup of 23 months 15 (79%) patients showed improvement or complete resolution of 1 or more signs or symptoms of hydronephrosis (7), increase in bladder capacity (5), recurrent UTI (6) and worsening incontinence (3). The remaining 4 patients had no response to NBE. No adverse effects were observed with 10 hours or less of nightly indwelling catheter time. CONCLUSIONS: Patients with NGB or NNGNGB on idealized daytime programs of CIC and urotropic drugs may have high intravesical pressures and experience urological deterioration because of an unrecognized SNOB. NBE is a simple technique for treating this condition and reversing the pathophysiological changes. The observation that NBE alone may increase bladder compliance and capacity sufficient to avoid bladder augmentation suggests that development of decreased bladder compliance and capacity in children with NGB may not simply represent normal progression of NGB disease. These changes may be avoidable consequences of untreated SNOB. Early institution of NBE may prevent urinary tract deterioration from developing in this population.

Adolescent↗
PubMed1996

Laparoscopic laser assisted auto-augmentation of the pediatric neurogenic bladder: early experience with urodynamic followup.

PURPOSE: We report our initial experience with laparoscopic laser assisted bladder auto-augmentation for treatment of the symptomatic pediatric neurogenic bladder. MATERIALS AND METHODS: Laparoscopic auto-augmentation of the bladder was performed in 2 children with myelodysplasia and high pressure neurogenic bladders unresponsive to medical management. Detrusorotomy was done using the KTP-532 laser. Laser energy was directed to the tissue to evaluate long-term effects of the procedure. RESULTS: Laparoscopic bladder auto-augmentation can be performed easily and with less morbidity compared to open auto-augmentation. Although results at 6 weeks showed improvement, enterocystoplasty was ultimately performed in both cases due to symptomatic recurrence of incontinence associated with increasing peak detrusor pressure and decreasing compliance. CONCLUSIONS: While this technique has the potential to offer minimally invasive correction in patients with low capacity, high pressure bladders, further modifications will be required to achieve long-term success.

Child↗
PubMed1990

[The effect of ganglioside on diabetic neurogenic bladder].

The effect of ganglioside was studied in 6 diabetic patients with neurogenic bladder. Ganglioside is glycosphingolipids which seems to be involved in the processes of nerve growth, regeneration and tissue reinnervation. The treatment consisted in the daily intramuscular administration of 20 mg ganglioside. Clinical symptoms, vibration sensation and urodynamic studies were recorded at the beginning and 4 weeks later. The clinical responses assessed by subjective complaints and vibration sensation were effective, but no statistically significant difference in urodynamic studies was obtained. Side effects were not observed. In conclusion, ganglioside treatment seems to have a positive effect on diabetic neurogenic bladder.

Aged↗
PubMed2004

Bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction.

The occurrence of bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction who used clean intermittent catheterisation to empty their bladders was studied in order to examine cut-off concentration breakpoints for significant bacteriuria in this group of patients using procedures of the European Urinanalysis Guideline. 344 samples were cultured, yielding 285 isolates. Coagulase-negative staphylococci (27%), Enterococci (25%), Klebsiella spp (19%), and Escherichia coli (12%) were the most common findings. Bacteria grew at concentrations of 10(5)-10(8) cfu/L, but only a few at 10(4) cfu/L. It is concluded that low bacterial concentrations in the urine (10(5) cfu/L) of patients with neurogenic bladder dysfunction who are on intermittent catheterisation might be as significant for bladder contamination with bacteria as a high bacterial concentration and can possibly be responsible for bladder infections.

Bacteriuria↗
PubMed1996

Endoscopic treatment of vesico-ureteric reflux in neurogenic bladder--8 years' experience.

During an 8-year period, 51 children with neurogenic bladder had endoscopic injection of Teflon (STING) for the management of 69 refluxing ureters. There were 21 boys and 30 girls (age range, 10 month to 16 years). Vesico-ureteral reflux (VUR) had been present for a mean of 4.1 years, and severity distribution was as follows: grade I, 1 ureter; grade II, 5 ureters, grade III, 9 ureters; grade IV, 39 ureters; and grade V, 15 ureters. The follow-up period ranged from 3 months to 8 years (mean, 4 years). Reflux ceased in 57 ureters (82%); in four ureters the VUR recurred (9 months to 6 years later). Bilateral vesico-ureteric junction (VUJ) obstruction occurred in one patient, which required surgical correction 3 years after STING. These data suggest that for difficult cases of VUR in neurogenic bladders, STING is a safe and effective option and should be the initial treatment of choice. However, because of the possibility of late recurrence of VUR or obstruction at the VUJ, long-term follow-up is required.

Adolescent↗
PubMed2001

Effect of a single-use sterile catheter for each void on the frequency of bacteriuria in children with neurogenic bladder on intermittent catheterization for bladder emptying.

OBJECTIVE: The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters. METHODS: A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded. RESULTS: A total of 158 urine samples were collected during 164 patient-weeks on the new catheter method for each void; 115 (73%) were positive for a pathogen. Of the 161 samples collected during 169 patient-weeks on the standard, reuse method for voiding, 123 (76%) were positive (115 [73%] of 158 vs 123 [76%] of 161). Escherichia coli was the most common pathogen detected during both method periods. CONCLUSION: A new, sterile catheter for each void did not decrease the high frequency of bacteriuria in patients with neurogenic bladder on intermittent catheterization.

Adolescent↗
PubMed1983

[The bethanechol test in the diagnosis of neurogenic bladder. 60 cases].

Bethanechol denervation hypersensitivity test seems useful although sometimes disregarded, for the diagnosis of lower neurogenic bladder. Our own experience of 60 patients is presented. When the indications are good (large capacity, hypotonic bladder, clinical suspicion of lower neuron lesion) and when the interpretation is based on a right understanding of its mechanism, this test appears to be very reliable. Except in 4 cases, the difference of pressure is greater than 20 or less than 10 cm H20. Factors susceptible to interfere with its accuracy are summarized. We must admit some discrepancies between the results of this test (exploring the pelvic nerve) and the perineal EMG (exploring the pudendal nerve); this fact is illustrated here. The importance of a wide bladder neck as a radiologic sign of neurogenic bladder is also stressed.

Bethanechol↗
PubMed2006

Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder.

PURPOSE: We evaluated botulinum-A toxin (Botox) injection into the urethral urinary sphincter in children with nonneurogenic neurogenic bladder to decrease urethral resistance and improve voiding. In these patients alpha-blocker medications had failed and injection was an alternative to unavailable biofeedback. MATERIALS AND METHODS: Prospective treatment was performed in 10 children 6 to 17 years old (mean age 8) with nonneurogenic neurogenic bladder using botulinum-A toxin (Botox). Preoperatively all children were evaluated by ultrasound, voiding cystourethrography, excretory urography, magnetic resonance imaging and urodynamic studies, including pressure flow, electromyography and uroflowmetry. One patient had unilateral G3 reflux and 4 had bilateral G1 to G3 hydronephrosis. Using a rigid pediatric endoscope and a 4Fr injection needle 50 to 100 IU botulinum-A toxin were injected into the external sphincter at the 3, 6 and 9 o'clock positions. Followup was 6 to 15 months. Repeat injections every month were given according to the response with a maximum of 3 injections. RESULTS: Immediately after botulinum-A toxin injection all except 1 patient were able to void without catheterization. No acute complications occurred. Four patients with bilateral hydronephrosis and the patient with the refluxing unit showed regression. Postoperatively post-void residual urine decreased by 89%, detrusor leak point pressure decreased significantly by a mean +/- SD of 66 +/- 18 vs 37 +/- 4 cm H(2)O and uroflowmetry showed a marked increase in maximum urine flow of 2 +/- 2 vs 17.8 +/- 8 ml per second. Three injections were needed in 1 patient to attain the desired response. CONCLUSIONS: Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

Adolescent↗
PubMed1997

Surgical versus endoscopic correction of vesicoureteral reflux in children with neurogenic bladder dysfunction.

PURPOSE: We attempted to compare the efficacy of subureteral polytetrafluoroethylene injection and ureteral reimplantation for treating vesicoureteral reflux in children with neurogenic bladder dysfunction. MATERIALS AND METHODS: We retrospectively studied the records of all children with neurogenic bladder dysfunction and reflux into single collecting systems treated with cross-trigonal ureteroneocystostomy or subureteral polytetrafluoroethylene injection. Followup cystography was performed 2 months postoperatively and ultrasound was done twice yearly thereafter. Urodynamic data were evaluated when available. Success was defined as complete eradication of reflux. Data were stratified by procedure, patient sex, grade and laterality of reflux, and the presence of unilateral or bilateral reflux, and then compared using chi-square analysis. RESULTS: Of 85 patients (118 ureters) identified followup data were available in 95%. Subureteral polytetrafluoroethylene injection and ureteroneocystostomy were done on 60 and 47 ureters, respectively. Both groups were similar in mean patient age, followup and preoperative degree of reflux. Success rates after ureteroneocystostomy and a single injection were 84.3 versus 56.7%. The cumulative success rate of subureteral polytetrafluoroethylene injection was 61% after a second injection. The success rate of ureteroneocystostomy was significantly greater than that of injection (p = 0.02). Reflux resolved in all patients in whom injection failed and who underwent secondary reimplantation. Successful ureteroneocystostomy was unrelated to patient sex, reflux grade or laterality, or bilateral versus unilateral reflux. Subureteral polytetrafluoroethylene injection was more likely to fail in higher grades of reflux (p = 0.03) but success was otherwise unrelated to other parameters. Failure to correct reflux was unrelated to urodynamic findings. CONCLUSIONS: Primary open ureteral reimplantation is more effective than subureteral polytetrafluoroethylene injection for correcting reflux in children with neurogenic bladder dysfunction. Despite controversy related to the appropriate injectable substance, the relative technical simplicity, outpatient nature, rapid recovery and potential for successful secondary reimplantation support a role for subureteral polytetrafluoroethylene injection in managing reflux in these difficult cases.

Adolescent↗
PubMed2006

Urodynamic study in the neurogenic bladder dysfunction caused by intervertebral disk hernia.

AIMS: To discuss the clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia. METHODS: Thirty patients with neurogenic bladder dysfunction caused by intervertebral disk hernia were divided into three groups according to the category of detrusor muscle activity: neurogenic detrusor overactivity without detrusor sphincter dyssynergia (DSD), neurogenic detrusor overactivity with DSD, or detrusor underactivity. The patients were divided into three groups according to the condition of urinary retention and incontinence: urinary retention, urinary incontinence, or neither urinary retention nor urinary incontinence. Also they were divided into three groups according to the location of the intervertebral disk hernia: cervical hernia, thoracic hernia, or lumbar hernia. All patients underwent computer tomography (CT), magnetic resonance imaging (MRI), and urodynamic study. The results were analyzed statistically. RESULTS: There was significant correlation between the category of detrusor muscle activity, bladder compliance (BC, P < 0.05), and the pressure at maximum flow (P(det,Qmax), P < 0.01). There were significant differences in post void residual (PVR), cystometric capacity (CC), and maximum flow rate (Qmax) between the three groups of urinary retention, urinary incontinence, and the group of neither retention nor incontinence (P < 0.05). There was statistical correlation between the location of the intervertebral disk hernia and the urodynamic results. There was significant correlation between the BC (the threshold was 15 ml/cmH(2)O), detrusor pressure (Pdet, the threshold was 40 cmH(2)O), DSD, the location of intervertebral disk hernia, and the upper urinary tract lesion (P < 0.01). CONCLUSIONS: Urodynamic studies are indispensable in the classification, diagnosis, treatment, and prognosis of the neurogenic bladder dysfunction caused by intervertebral disk hernia.

Adult↗
PubMed1992

Neurogenic bladder due to peripheral neuropathy and a visual disturbance in an elderly man with systemic lupus erythematosus.

A 63 year old man with central nervous system lupus with a neurogenic bladder and visual disturbance is described. The diagnosis of neurogenic bladder, attributed to peripheral neuropathy, was made on the basis of cystometrography and clinical symptoms. A brain magnetic resonance imaging scan showed gliosis along the cerebral vessels and the optic nerve. This case shows that systemic lupus erythematosus can be accompanied by a peripheral neurogenic bladder and visual disturbance, and that these symptoms may not improve despite the amelioration of other lupus symptoms on treatment with steroids.

Follow-Up Studies↗
PubMed1976

Preliminary evaluation of alpha-adrenergic blocking agents in children with neurogenic bladder due to myelomeningocele.

Twenty children with myelomeningocele and neurogenic bladder dysfunction were treated with alpha-adrenergic blocking agents. The results were satisfactory and are considered to justify the use of these drugs, especially for children who have weak or absent detrusor activity and urethral outflow resistance not of the dyssynergic type. There are indications that urinary diversion in such cases may be able to be postponed when alpha-adrenergic blocking agents are used more routinely.

Anal Canal↗
PubMed1987

[A case of solitary pelvic kidney with vesicoureteral reflux and neurogenic bladder dysfunction].

A case of solitary pelvic kidney with neurogenic bladder dysfunction with vesicoureteral reflux is presented. The patient was a 15-year-old boy with sacral vertebral dysplasia and hare-lip, and he has been complaining of recurrent fever episodes and urinary incontinence since 11 years old. Renal anomaly was confirmed by DIP, CT and angiography, and grade IV vesicoureteral reflux was demonstrated by voiding cystourethrography. On cystometrography, low compliance bladder which had a 70 ml capacity on first desire to void and 90 ml capacity on maximum desire to void was observed. Electromyography of anal sphincter performed with uroflowmetry revealed no relaxation of external sphincter during voiding. To preserve renal function, antireflux surgery was performed by Cohen's method, and a successful result, that is cessation of reflux and no ureteral obstruction, was achieved. After operation, periodic transcutaneous electrical stimulation were applied to the pudendal nerve, as a result bladder capacity increased to 150 ml and dysuria with incontinence improved.

Adolescent↗
PubMed1977

Evaluation and management of infants and children with neurogenic bladders.

The clinical management of infants and children with neurogenic bladder dysfunction relies heavily on radiologic studies to follow the status of the upper tracts. Radiology also plays a vital role in the evaluation of patients who are candidates for insertion of an artificial urinary sphincter, or reconstruction of their previously diverted urinary tracts.

Child↗