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PubMed1978

[Conservative-surgical therapy of the neurogenic bladder].

If physical therapy and drugs remain unsuccessful in the treatment of the neurogenic bladder, conservative-operative interventions should be performed prior to urinary diversion. Bladder neck incision, supraselective neurectomy and implantation of a bladder pacemaker in highly selected patients offer a good chance of avoiding diversion. In 64 cases of bladder neck incision, 80% improved or were cured. Experience with the neurectomy in patients with hyperactive detrusor is still limited. The preliminary results, however, proved that this technique should be included in the treatment of neurogenic bladder. 8 of 11 patients in whom a bladder pacemaker was implanted showed voiding following implantation. 7 patients displayed reflex evacuation.

Female↗

PubMed1975

Use of ileocystoplasty in the hypertonic neurogenic bladder.

An ileocystoplasty was used successfully in the management of incontinence secondary to a hypertonic neurogenic bladder. The indications for its use and possible benefits in patients with neurogenic bladder have been discussed.

Child↗

PubMed2003

[Treatment of vesicoureteral reflux in patients with neurogenic bladder. Should the ureter be reimplanted in patients treated with augmentation cystoplasty?].

OBJECTIVES: To evaluate the necessity of performing ureteral reimplantation in patients with vesicoureteral reflux secondary to neurogenic bladder. METHODS: Retrospective review of 19 patients (10 males and 9 females), between 2 and 19 years of age (Mean age 7 years), with neurogenic bladder and vesicoureteral reflux (VUR) treated from May 1990 to July 2000. No one patient had a satisfactory response to the therapy with anticholinergic drugs and clean intermittent catheterization. All 19 patients underwent augmentation cystoplasty (15 using sigmoid colon and 4 ureter). Ten patients, 16 renal units, underwent simultaneous ureteral reimplantation. RESULTS: All patients improved their bladder capacity and compliance after bladder augmentation. VUR disappeared in 17 patients. Two patients (3 renal units) in the group without ureteral reimplantation remained with a minor degree of reflux. CONCLUSIONS: Bladder augmentation alone resolves VUR secondary to neurogenic bladder in a high percentage of patients.

Adolescent↗

PubMed1984

Clean intermittent catheterization in the management of the neurogenic bladder in children.

Clean intermittent catheterization has been successful in the management of urinary incontinence and upper tract changes associated with a neurogenic bladder. The results of clean intermittent catheterization controlling urinary incontinence, ureteral reflux, upper tract dilatation and urinary infection in 84 children with a neurogenic bladder were evaluated for up to 3 years of followup. Of the children 41 (49 per cent) were totally incontinent and 14 (17 per cent) were slightly damp. Preexisting ureteral reflux deteriorated in 25 per cent of the patients, ceased in 35 per cent and was unchanged in 40 per cent, while pre-existing upper tract dilatation improved in 12.5 per cent and was unchanged in 87.5 per cent. On clean intermittent catheterization and antibacterial medication 90 per cent of the children had sterile urine and 7.5 per cent had 10(5) or more colonies per ml. Complications occurred on 54 occasions but were minor in nature and were corrected easily. Half of the parents, schools and children found clean intermittent catheterization very acceptable or acceptable but a quarter of the parents and patients found it unacceptable or slightly unacceptable, or were undecided. Initial management of urinary complications associated with neurogenic bladder in children has changed to the clean intermittent catheterization program, with greatly improved results compared to Credé's expression of the bladder, an indwelling urethral catheter or urinary diversion. However, the clean intermittent catheterization regimen was not effective completely, not without complications and not accepted completely by parents, schools and children.

Adolescent↗

PubMed1981

The management of vesicoureteral reflux in the pediatric neurogenic bladder.

An integrated method of management has been used in 29 children with neurogenic bladders and vesicoureteral reflux. Radiological followup reveals that resolution or improvement of reflux occurred in 48 per cent of the renal units managed by close observation only, 48 per cent managed by intermittent catheterization, 75 per cent managed by vesicostomies and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy. A protocol of management is outlined.

Child↗

PubMed2000

Dosage escalation of intravesical oxybutynin in the treatment of neurogenic bladder patients.

OBJECTIVE: We prospectively analyzed the dose dependent outcome and side effects of neurogenic bladder patients with intravesical application of oxybutynin at our centre. MATERIALS AND METHODS: We examined the data of 32 patients with neurogenic bladders and detrusor hyperreflexia. We registered clinical outcome, continence situation, side effects and urodynamic data of patients with (A) standard dosages of intravesical oxybutynin (0.3 mg/kg bodyweight per day) and (B) with increasing dosages in steps of 0.2 mg/kg bodyweight per day up to 0.9 mg/kg bodyweight per day. RESULTS: We examined 32 patients aged 1 to 34 years, mean age 12 years. 21/32 patients became totally continent with the dosage (A). They showed a significant (P<0.01) decrease in the median max detrusor pressure (MDP) and a significant (P<0.01) increase in the median compliance and the median age adjusted bladder capacity (AABC). Eleven out of 32 patients remained incontinent under this dosage (A). Their median MDP, their median compliance and their median AABC remained nearly unchanged. Seven out of 11 incontinent patients under dosage (A) were treated efficiently with the higher dosages (B). Their median necessary dosage escalation to achieve treatment success was 0.7 mg/kg bodyweight per day (range 0.5 to 0.9 mg/kg bodyweight per day). Their median MDP was significantly (P<0.05) decreased and their median compliance and median AABC were significantly (P<0.05) increased. Four out of 11 patients remained incontinent and showed only little improvement in urodynamic data. Two out of 11 patients with the dosage escalation (B) showed side effects at a dosage of 0. 9 mg/kg bodyweight per day. CONCLUSIONS: The intravesical application of oxybutynin was a well tolerated and efficacious therapy. The topical oxybutynin therapy dosage (A) was efficient in 66% of our selected patients, the escalating dosage titration (B) could increase the efficiency to 87%.

Administration, Intravesical↗

PubMed1991

Ileocecocystoplasty for the management of refractory neurogenic bladder: surgical technique and urodynamic findings.

A total of 21 incontinent adults with a neurogenic bladder who were refractory to conservative management underwent a modified technique of ileocecocystoplasty. Followup ranged from 1 to 6 years (mean 3.1 years). To ensure a wide anastomosis the augmentation was accomplished by suturing a detubularized ileocecal patch to a large posterior based bladder flap anchored to the psoas muscles. Postoperatively 20 of 21 patients were continent. The remaining woman was cured after surgical correction of sphincteric incontinence. Mean bladder capacity increased from 185 +/- 17 to 595 +/- 43 ml. (standard error). Mean maximum detrusor pressure decreased from 53 +/- 6.3 to 16 +/- 2.3 cm. water (p less than 0.0001). Followup revealed a persistently large capacity, low pressure reservoir in all patients. No patient required anticholinergic medication. None experienced acid-base imbalance, tumors in the augmented bladder or upper tract deterioration. We conclude that this technique of ileocecocystoplasty is suitable for the management of patients with a refractory neurogenic bladder.

Adult↗

PubMed2005

Health-related quality of life of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury.

OBJECTIVES: To determine the psychological and social status of patients using clean intermittent catheterization for neurogenic bladder according to health-related quality of life (HRQOL). METHODS: We conducted a prospective trial involving 132 patients (81 men and 51 women, mean age 41.8 years, range 18 to 80 years) using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury. The 150 controls (90 men and 60 women) lived in the same region as the patients and were frequency matched to ensure equal age and sex distributions. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36). RESULTS: The SF-36 scores did not reveal any significant differences between the men and women in the patient group. The SF-36 scores of the patients were significantly lower than those of the general population. When patients and controls were divided into two groups according to sex and age, the SF-36 scores of the patients were significantly lower than the controls across both sex and all age groups, other than the energy and vitality scale, the differences for which were not statistically significant in women and those younger than 50 years. CONCLUSIONS: Our findings suggest that patients using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury generally exhibit a reduced quality of life in all health domains as assessed by the SF-36.

Adolescent↗

PubMed1977

The upper urinary tract in neurogenic bladders without diversion---a ten-year follow-up.

Within the first 5 years of life, 50% of children with neurogenic bladders developed subvesical obstruction. Children with neurogenic bladders who did not developed subvesical obstruction (according to group I) up to the age of 5 years are not likely to develop obstruction unit they reach the age of 10 years. Children who do develop such an obstruction before the age of 5 years are possible candidates for urinary diversion.

Adolescent↗

PubMed1976

Long-term results of obstructive neurogenic bladder in children with myelomeningocele.

A total of 91 children with myelomeningocele and neurogenic bladder were followed up for periods of between five and 10 years. The results of investigations of the upper and lower urinary tracts at the ages of three months, five years and 10 years showed that subvesical obstruction was rare in the infant period but that it increased year by year as the children grew older. By the age of five years 50 per cent of the children in this sample had severe obstructive changes. The study shows that children with neurogenic bladder who reach five or six years of age without developing severe symptoms of progressive subvesical obstruction will stand a good chance of being able to be treated conservatively.

Child↗

PubMed1975

External sphincterotomy in traumatic and non-traumatic neurogenic bladder dysfunction.

Experience with external sphincterotomy in 40 patients with traumatic and non-traumatic neurogenic bladder is reviewed. The procedure is a safe, reliable technique designed to establish a balanced neurogenic bladder in patients with detrusorsphincter dyssynergia. Spincterotomy should be performed in most patients before consideration of supravesical diversion.

Follow-Up Studies↗

PubMed1993

Treatment of vesicoureteric reflux in the neurogenic bladder.

A retrospective co-operative study was conducted among 6 Italian paediatric surgical departments to assess the results of different forms of treatment of vesicoureteric reflux in patients with neurogenic bladder. Between January 1980 and December 1989 we studied 641 neurogenic bladders in children, mainly due to spina bifida; reflux was detected in 199 patients with 263 refluxing ureters. Details of treatment were available for only 170 patients and they were divided into 2 main groups: conservative medical treatment (n = 127) and primary surgical treatment (n = 43). Medical treatment consisted mainly of clean intermittent catheterisation and the administration of appropriate drugs. In the surgical group 36 reimplantations, 6 cystostomies and 1 STING were performed. Fifteen patients underwent surgery as a secondary procedure. The results showed that approximately 50% of patients with reflux were cured by clean intermittent catheterisation and drug therapy. Ureteric reimplantation can be safely performed in patients with neurogenic bladder provided that a normally compliant, non-hyper-reflexic bladder can be achieved by means of drugs or by bladder augmentation with bowel.

Child↗

PubMed2006

Changing composition of renal calculi in patients with neurogenic bladder.

PURPOSE: Renal calculi are a significant source of morbidity for patients with neurogenic bladder. Calculi from patients with NB have traditionally been composed primarily of struvite and carbonate apatite secondary to chronic urea-splitting bacteriuria. In the current era there have been great improvements in the urological rehabilitation of patients with NB. We defined the composition of renal calculi in a contemporary cohort of patients with NB due to spinal cord injury or myelomeningocele who underwent percutaneous nephrolithotomy. MATERIALS AND METHODS: We performed a retrospective evaluation of all patients with NB due to SCI or MM who underwent PNL between January 2002 and January 2005. RESULTS: A total of 32 patients with NB (14 with SCI, 18 with MM) underwent PNL in this period. Stones were infectious in etiology in 37.5% (12 struvite/carbonate apatite) and metabolic in 62.5% (1 uric acid, 2 calcium oxalate monohydrate, 2 brushite, 6 hydroxyapatite, 9 mixed hydroxyapatite/calcium oxalate). All patients with struvite calculi were infected with urea-splitting bacteria on preoperative urine culture. CONCLUSIONS: Patients with neurogenic bladder are traditionally thought to harbor infection related calculi. These data demonstrate that many contemporary patients will be found to have calculi of a metabolic etiology. Although patients with NB still have renal calculi, advances in urological treatment may have affected the composition of their calculi, as metabolic stones are becoming more commonly identified. When metabolic components are identified, stone activity may be attenuated with appropriate metabolic evaluation, pharmacological therapies and dietary modifications.

Adolescent↗

PubMed1978

[Conservative drug therapy of neurogenic bladder disorders].

Today neuropharmacas are a helpful part in the conservative treatment of the neurogenic bladder disorders. They are, or course, no "wonder-drugs" and usually lead to an improvement only of the troubles, but rarely to complete cure. If monotherapy does not lead to the results wanted, one should combine drugs of the same of similar effects but with different pharmacologic targets. A real progress was reached through alpha-receptor-blockers, whose use has, especially in children with myelomeningocele, changed the therapeutic concept in favour of a largely conservative treatment. We already know a number of substances that in one way or other influence the muscles of the bladder and the bladder outlet. If only part of them will reach clinical usage, it can be assumed that the pharmacotherapy will become even more meaningful in the treatment of neurogenic bladder disorders.

Adrenergic alpha-Antagonists↗

PubMed1997

Intravesical therapy for the treatment of neurogenic bladder in children.

BACKGROUND: Oral pharmacotherapy has been commonly used as an adjunct to clean intermittent catheterization (CIC) in the treatment of neurogenic bladder in order to achieve continence, but may be associated with unacceptable side effects. The authors' experience with sterile intravesical preparations of oxybutynin hydrochloride and ephedrine in children is reported here. METHODS: Patients requiring CIC for neurogenic bladder but with incontinence that was unresponsive to standard oral therapy or that was associated with severe systemic side effects were studied over a 1-year period. Clinical, radiological and urodynamic assessments were made prior to commencing treatment with intravesical oxybutynin hydrochloride. Patients who remained incontinent with poor internal sphincter muscle tone had intravesical ephedrine added. RESULTS: Seven patients were involved in the study over a 1-year period. Two patients became continent and one patient had an improvement in upper tract dilatation. One patient had a limited improvement with oxybutynin alone but became continent with the addition of ephedrine. Three patients had no response to treatment. There were few side effects. CONCLUSION: Intravesical agents have a role in the management of paediatric neurogenic bladder for those children with significant adverse sequelae from oral pharmacotherapy who would otherwise require surgical intervention. Intravesical therapy is a safe technique in children with sterile preparations. Further investigation of this modality should be pursued.

Administration, Intravesical↗

PubMed1980

Supersensitivity to prostaglandin in chronic neurogenic bladders.

The bladder response to prostaglandin (PG test) was investigated in chronic neurogenic bladders by isometric cystometry and compared with the results obtained from normal subjects. The urinary bladder was filled with 100 ml of saline and 100 micrograms of prostaglandin 995 were injected intravenously. The changes in bladder and intra-abdominal pressures were observed for up to 20 min. A rise in detrusor pressure of more than 20 cm of water was judged a positive response. Out of 21 neurogenic bladders 12 had a positive response. The result of the PG test demonstrated a good correlation with the supersensitivity test to bethanechol chloride which was performed on these patients on a different day. All of the normal subjects had negative responses. It was concluded that the chronically denervated bladder is supersensitive to prostaglandin 995.

Adolescent↗

PubMed2004

Sacral neuromodulation for neurogenic bladder dysfunction in children.

PURPOSE: We report a prospective randomized controlled study to evaluate the possible benefits of sacral neuromodulation (SNM) for the management of neurogenic bladder dysfunction in children. MATERIALS AND METHODS: We included in the study subjects between the ages of 5 and 21 years presenting with urinary incontinence due to neurogenic bladder. Before study inclusion all previous treatment was discontinued. Patients were randomly divided into the control group treated conventionally and the implant group treated with SNM. Treatment outcome was compared every 3 months for a minimum of 12 months based on clinical examination, voiding diary and urodynamic evaluation. RESULTS: A total of 26 boys and 16 girls with a mean age of 11.9 years were enrolled in this study. There were 21 patients in each group. The main underlying etiology was spina bifida. The 2 groups were comparable with regard to sex, age and urodynamic variables. Total disappearance of urinary leakage was observed in 1 patient who underwent implantation but he still required intermittent catheterization. Comparison of urodynamic variables disclosed no significant statistical difference except with regard to functional bladder capacity which was better in the control group and the leak point pressure which was better in the implant group (p <0.05). Evaluation of interindividual variations in the implant group revealed significant improvement in compliance and functional bladder capacity at 6 and 9 months but not at 12 months. Nine patients in the implant group reported improvement in intestinal transit, 5 total disappearance of urinary infection and 6 persistent sensation of a full bladder. No patient in the control group reported any improvement. Revision surgery was required in 3 cases due to lead migration, faulty connection and wound infection. CONCLUSIONS: SNM is a promising new therapeutic modality. Implant placement is minimally invasive, nondestructive and reversible. Use in children with neurogenic bladder has not been previously reported. Although some improvement was noted in patients treated with SNM, the difference with the control group was not significant. A larger multicenter study is warranted to evaluate SNM.

Adolescent↗

PubMed1995

Endoscopic correction of vesicoureteral reflux in patients with neurogenic bladder dysfunction.

Transurethral injection of Teflon paste (TUI) was carried out in 24 ureters of 16 patients with vesicoureteral reflux (VUR) secondary to neurogenic bladder dysfunction at an age ranging from 4 to 77 years, and the results were compared with those of conventional open surgery. During the mean follow-up period of 20.1 months, reflux disappeared in 19 ureters (79%), so that the success rate of endoscopic operation was considered to be satisfactory as compared with that of conventional open surgery, in which reflux disappeared in 16 (80%) of 20 ureters in 16 patients with neurogenic bladder dysfunction at our department. No exacerbation of hydronephrosis was observed postoperatively, and no complication was noted. This procedure, which is minimally invasive and technically simple, may be regarded as the first choice for VUR secondary to neurogenic bladder dysfunction.

Adolescent↗