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At least 289 records · Page 16Linked to original sources
PubMed2000

Long-term efficacy of subureteral collagen injection for endoscopic treatment of vesicoureteral reflux in neurogenic bladder cases.

PURPOSE: We evaluated the long-term efficacy of subureteral glutaraldehyde cross-linked collagen injection (GAX 35) for endoscopic treatment of vesicoureteral reflux in patients with neurogenic bladder dysfunction due to meningomyelocele. MATERIALS AND METHODS: We prospectively studied 12 women and 8 men (26 ureteral renal units) with a median age of 8 years (range 1 to 51) who had neurogenic bladder due to meningomyelocele. Reflux into single collecting systems was treated with subureteral collagen injection (GAX 35). Followup with video urodynamics included voiding cystography. RESULTS: All patients performed intermittent catheterization to control the bladder. During the study all bladders were areflexic with normal compliance. Preoperative reflux according to the International Reflux Study Classification was grade I in 1, II in 9, III in 10, IV in 4 and V in 2 ureteral renal units. All patients were treated with subureteral collagen injection (mean volume 1.9 ml., range 0.7 to 3.5). Reflux resolved initially in all but 2 cases. Mean followup was 16 months (range 1 to 71). Reflux was still absent in only 15% of treated units after 24 months. CONCLUSIONS: Our data suggest that endoscopic subureteral collagen injection in neurogenic bladder cases is not effective with long-term followup. New biocompatible and biodegradable materials should be tested to control vesicoureteral reflux.

Adolescent↗
PubMed1980

Experiences with urinary undiversion in children with neurogenic bladder.

Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.

Adolescent↗
PubMed1979

Experiences with urinary undiversion in children with neurogenic bladder.

Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.

Adolescent↗
PubMed2003

Structural basis of neurogenic bladder dysfunction. I. Methods of prospective ultrastructural study and overview of the findings.

PURPOSE: We standardize procedures for ultrastructural study of detrusor smooth muscle and intrinsic nerves in neurogenic bladder dysfunction in the human, and present an overview of the findings. MATERIALS AND METHODS: The study included 18 female and 33 male patients 7 to 96 years old. They had neurogenic bladder dysfunction with hyperreflexia for less than 1 to 43 years, resulting from upper motoneuron lesions (spinal cord injury 25, brain disorder 17) or combined upper and lower motoneuron deficit (meningomyelocele 9). Endoscopic or open bladder biopsies were processed for ultrastructural study of detrusor smooth muscle and intrinsic neural elements. Qualitative morphologic criteria of muscle cell arrangement, degeneration and cell-cell contacts, as well as those of degeneration and regeneration of intrinsic neural elements are defined. RESULTS: Five biopsies from the brain disorder group had insufficient smooth muscle and were excluded from study. The remaining 46 biopsies were evaluated by electron microscopy, and all displayed the complete dysjunction pattern of detrusor overactivity. Most displayed degeneration and regeneration of intrinsic axons but disproportionately limited muscle cell degeneration, irrespective of detrusor contractility. The brain disorder group biopsies displayed many more ultrastructurally normal axons than the meningomyelocele and spinal cord injury group biopsies (median 33% versus 8% or less). CONCLUSIONS: Upper motoneuron neurogenic bladder dysfunction in humans is associated with intrinsic neuromuscular defects in the detrusor. Ultrastructural features of these defects suggest morphologic markers that not only may distinguish neuropathic from nonneuropathic bladder dysfunction, but also may point to the anatomical level of the neurogenic deficit.

Adolescent↗
PubMed1998

A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients--a preliminary report.

Eighty patients with spinal cord injury (SCI) and neurogenic bladder were studied. Among them, 28 (70%) cases in the control group and 32 (80%) cases in the electroacupuncture group achieved ultimately balanced voiding and were selected for further analysis. The acupuncture group received electroacupuncture at four acupoints: Chung Chi (Conception Vessel CV3), Kuan Yuan (CV4), and bilateral Tzu Liao (Urinary Bladder UB32), in addition to conventional intermittent catheterization program (ICP). Whereas the control group underwent conventional bladder training program with ICP only. The results revealed that the time of achieving balanced voiding was statistically significantly shorter with electroacupuncture than in the control group: 57.1 +/- 22.6 vs 85.2 +/- 27.4 days (P < 0.005) for upper motor neuron lesions, and 55.4 +/- 22.6 vs 83.4 +/- 26.1 days (P < 0.01) for lower motor neuron lesions. However, there was almost no difference between upper motor neuron lesions and lower motor neuron lesions. When acupuncture commenced was alos a factor to influence the results. Those who received acupuncture within 3 weeks after injury had significantly shortened the total days to achieve a balanced bladder, as compared to those who received acupuncture 3 weeks after injury (46.6 +/- 13.2 vs 65.8 +/- 15.4 days, P < 0.005). Our study implied that acupuncture might be beneficial in the management of neurogenic bladder of SCI, and the earlier the patient received electro-acupuncture therapy, the sooner the bladder balanced. On the other hand, we also found that complete spinal cord injury, either with pronounced detrusor-sphincter dyssynergia in upper motor neuron lesion or with persistent areflexic bladder in lower motor neuron-lesion, was not affected by acupuncture.

Acupuncture Therapy↗
PubMed1995

Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction.

OBJECTIVE: To study the long-term outcome of patients undergoing enterocystoplasty. PATIENTS AND METHODS: The study comprised 48 patients (17 men and 31 women; mean age 46 years) who underwent enterocystoplasty for idiopathic detrusor instability (DI, 35 patients) or neurogenic bladder dysfunction (13 patients). Symptoms were scored from 0 to 14 and the overall outcome and generic quality of life were assessed using a Visick grading system (groups A to E) and the Nottingham Health Profile (NHP). These assessments were carried out before, 3 months after operation and at the final follow-up (38 +/- 18 months, range 13-78). Urodynamic studies were performed before and after operation. RESULTS: No patient died after operation and there was minimal early morbidity. Late complications (> 30 days) included incisional hernia (3), anastomotic perforation (1), calculus formation (1) and urethral stricture (1). Clean intermittent self-catheterization (CISC) was performed by 36 (75%) patients. Early symptomatic outcome was good in 40 (83%) patients, moderate in seven (15%) and unsatisfactory in one (2%) patient. The mean symptom scores before and 3 months after surgery were 10 (range 2-14) and 3 (range 2-14), respectively (P < 0.001). There was a significant increase in total bladder capacity (307 +/- 140 to 588 +/- 217 mL; P < 0.001) and bladder compliance (37 +/- 50 to 169 +/- 162 mL/cm H2O; P < 0.001). DI persisted in 15 (31%) patients. NHP scores revealed significant improvements in all domains. Final assessment showed a less satisfactory situation, with recurrent urinary tract infection (UTI) in 17 (37%) patients, a need for long-term antibiotic therapy in seven (15%) and a change in bowel habit in 15 (33%) (13 DI, two with neurogenic bladder dysfunction). CISC was performed by 39 (85%) patients. The long-term outcome was good or moderate in 12 patients (92%) with neurogenic bladder dysfunction and good or moderate in only 19 patients (58%) with DI. CONCLUSION: Clam enterocystoplasty remains an effective management option in some patients with DI, but most patients with neurogenic bladder dysfunction do well. The procedure is, however, associated with long-term complications such as disturbance of bowel habit and recurrent UTIs, which impair the outcome in the long-term in patients with DI despite general improvements in irritative bladder symptoms.

Adult↗
PubMed1993

[Transurethral teflon paste injection for vesicoureteral reflux in neurogenic bladder dysfunction].

We experienced transurethral teflon paste injection for 12 refluxing ureters of 7 patients with neurogenic bladder dysfunction. Preoperative assessment of cystometry showed hypoactive bladder function with normal bladder compliance in 4 patients, and low compliance bladder (< 10 ml/cmH2O) in 1. Voiding cystography revealed grade 1 reflux in 2 ureters, grade 2 in 3, grade 3 in 2, grade 4 in 2, and grade 5 in 2. One ureter did not show reflux. Zero point two to 1.6 ml of teflon paste was injected on each ureter under cystoscopic observation. These patients were followed for a mean of 25.1 months. Reflux disappeared immediately after the first operations in all patients, however recurrence was observed in 2 ureters, in which improvement of reflux (grade 5 to 2) was achieved in 1 ureter but no improvement (grade 2 to 2) in another. Pyelonephritis was not encountered in any patients after injection. No complication was observed through the follow up period. In conclusion, we advocate that endoscopic teflon paste injection is a useful alternative to ureteroneocystostomy in the treatment of reflux in patients with neurogenic bladder dysfunction.

Aged↗
PubMed1998

Comparison of questionnaire-based and serological screening for natural latex allergy in children with neurogenic bladder dysfunction.

OBJECTIVE: We evaluated the prevalence of sensitization to natural latex in children with congenital neurogenic bladder dysfunction by patient history and serological examinations. METHOD: 50 consecutive children aged from 6 months to 17 years were included into the study which comprised questionnaires of patient and family histories, serological screening tests for common inhalational allergens (CAP SX1), and determination of total serum immunoglobulin E (IgE) and of latex-specific serum IgE by solid-phase immunoassays. RESULTS: 5 children had a history of allergic reactions to natural latex; a history of atopic disposition or allergic reactions other than to latex was present in 16 children. In 10 children, latex-specific IgE levels were elevated: > 0.35 kU/l; 6 out of these 10 children had no history of allergic reactions to latex. Elevated latex-specific IgE values were statistically correlated with the number of past operations (p < 0.006) and a history of atopic or allergic reactions (p < 0.0067). Clean intermittent catheterization, however, was not associated with an increased risk of latex allergy (p = 0.408). CONCLUSION: When screening children with congenital neurogenic bladder dysfunction for sensitization to natural latex, serological examinations of latex-specific IgE in addition to patient history may better identify patients at risk.

Adolescent↗
PubMed2004

Can higher doses of oxybutynin improve efficacy in neurogenic bladder?

PURPOSE: We evaluated the efficacy and tolerability of higher dose oxybutynin chloride in patients with neurogenic bladder and multiple sclerosis, spinal cord injury or Parkinson's disease. MATERIALS AND METHODS: The study design was a prospective, 12-week dose titration trial of controlled release oxybutynin (OXY-XL). A 7-day washout period was used before initiation of the starting dose of 10 mg OXY-XL. Doses of OXY-XL were increased by 5 mg at weekly intervals to a maximum dose of 30 mg per day guided by patient perception of efficacy versus side effect. Voiding diaries were completed at baseline, and weeks 6 and 12. Post-void residuals were recorded. Criteria for study admission included post-void residual less than 200 ml. RESULTS: Of the 39 patients enrolled in the study 22 had multiple sclerosis, 10 had spinal cord injury and 7 had Parkinson's disease. There were 29 women (74%) and 10 men (26%). Within 1 week a decrease in the number of voids per day was seen in greater than 50% of the subjects. At the end of the study statistically significant decreases in the number of voids in 24 hours, episodes of nocturia and incontinence episodes were observed. Residual urine remained unchanged from 33.9 +/- 7.6 ml at baseline to 51.3 +/- 10.4 ml after 12 weeks at the final dose (p = 0.17). No patient experienced serious adverse events and none dropped out during the course of the 12-week study. At the end of the study 20.5% of subjects remained on 30 mg, 15.4% on 25 mg, 23.1% on 20 mg, 15.4% on 15 mg and 25.6% on 10 mg OXY-XL. CONCLUSIONS: Aggressive dosing of OXY-XL is safe and effective in patients with neurogenic bladder. Compared with nonneurogenic overactive bladder, higher doses of OXY-XL (15 mg daily or greater) were requested by 74.4% of the patients in our study. The onset of clinical efficacy can occur within 1 week, and doses up to 30 mg are well tolerated and effective in this population.

Adult↗
PubMed1986

Clinical reevaluation of the effect of oxybutynin chloride on uninhibited neurogenic and reflex neurogenic bladder.

Oxybutynin chloride has been clinically used for the relief of symptoms associated with voiding in patients with uninhibited neurogenic and reflex neurogenic bladder in the USA. The present clinical and urodynamic studies were the first meticulously in patients with uninhibited neurogenic and reflex neurogenic bladder in Japan. A single oral dose of oxybutynin chloride (3 or 6 mg) did not induce any change either in subjective symptoms or in urodynamic studies; however, in the continual administration study, 7 of 9 patients showed an improvement in the symptoms associated with voiding. The drug reduced urinary frequency, urgency and incontinence, and significantly increased the volumes at the first desire to void (FDV) and maximum desire to void (MDV) in cystometry. Furthermore, no serious adverse reactions were observed, and hence the drug seems to be of clinical significance.

Aged↗
PubMed1976

Types of neurogenic bladder in children with spina bifida, and response to treatment with phenoxybenzamine.

Seventeen children with spina bifida and neurogenic bladder were treated with phenoxybenzamine, an alpha-blocking agent, and in 15 cases the treatment was successful. It is suggested that in certain types of neurogenic bladder the need for urinary diversion can be avoided by treatment with phenoxybenzamine; only if this treatment fails does urinary diversion become necessary.

Child↗
PubMed1977

Vesico-ureteral reflux and uninhibited neurogenic bladder.

Ureteral reflux in female patients who also have latent uninhibited neurogenic bladder occurs synchronously with uninhibited contraction, is blocked by buscopan and is aggravated by besacholine. Intrinsic neuromuscular antireflux mechanism of the vesicoureteral junction (VUJ) appears to be affected by unknown ways with uninhibited contraction. Urethrovesical reflux observed synchronously with uninhibited contraction seems to play an additional role in the genesis of urinary infection. A different look is required in the management of these refluxes, in that concomitant use of the anticholinergic drugs is recommended in addition to the conventional approach for the control of infection, reflux and voiding symptoms.

Child↗
PubMed2001

[Dermatography. An effective method for pacemaker marking after spinal cord injuries and implantation of a Brindley stimulator for neurogenic bladder].

In our department, two spinal cord lesion patients suffering from neurogenic bladder dysfunction were selected for the implantation of a Brindley stimulator, as they could not be managed by conservative treatment. Accurate positioning of the external transmitter block over the subcutaneous receiver block, which is essential for the Brindley stimulator to function correctly, posed problems for the relatives who had to apply the external transmitter. In order to facilitate positioning, dermatography was used to mark the exact spot where the external transmitter should be placed. A 3-year follow-up showed that this marking solved the problem completely and that recurrent urinary tract infections stopped.

Artificial Organs↗
PubMed2005

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part I: Bladder augmentation and bladder substitution--therapeutic algorisms.

After the failure of conservative treatment of neurogenic bladders (deterioration of the upper urinary tract/incontinence), bladder augmentation/bladder substitution and supravesical urinary diversion have to be considered. In our concept, bladder augmentation is indicated for hyperreflexive and small low compliance bladders with normal upper urinary tracts. In cases with combined sphincteric incompetence, a fascial sling (FS) can be required to achieve continence. In patients with small and hyperreflexive bladders, high-grade reflux and/or dilatation of the upper tracts, bladder substitution and ureteral reimplantation are appropriate. For patients with irreparable sphincter defects and those who are unable to perform transurethral self-catheterization, continent cutaneous diversion is offered. For patients with chronic renal failure, deterioration of the upper urinary tract and those who are not able to perform a self-catheterization of a continent stoma, colonic conduit diversion is our therapy of choice. The current study aims to investigate the long-term safety of our concept for these patients in regard to protecting the upper tracts and providing continence. Between 1968 and 2002, 170 children and adolescents underwent surgery. Of these, 24 received an orthotopic reservoir (bladder augmentation, n =10; combined with FS, n =1; orthotopic bladder substitution with ureteral reimplantation, n =14). The material, methods and results of the remaining 146 patients are reported in parts II and III. One of the 24 patients with an orthotopic reservoir was lost to follow-up. An average follow-up of 9 years (1.3-18 years; median 8.7 years) was available in 23 patients with 42 RUs. As compared to preoperatively, the upper urinary tracts remained stable or improved in all ten patients with bladder augmentation and in 20/23 renal units (RUs) with bladder substitution at the latest follow-up. Eight of ten patients with bladder augmentation are continent. All 13 patients with bladder substitution are continent during the day; one requires a safety pad at night. Bladder augmentation has been effective in patients with hyperreflexive and small low compliance bladders and normal upper urinary tracts. In those with high-grade reflux and/or dilatation of the upper tracts, bladder substitution and ureteral reimplantation are recommended. In very selected patients a fascial sling (FS) can be required to achieve continence.

Acid-Base Equilibrium↗
PubMed1976

Management of neurogenic bladder dysfunction in the adult.

A review of the management of neurogenic bladder dysfunction in the adult is presented. The various modes of therapy are classified according to their effects on bladder contractility and outlet resistance, providing a logical framework for discussion.

Autonomic Nerve Block↗
PubMed1979

Long-term followup of anterior urethral transposition in female patients with neurogenic bladder.

Between 1961 and 1976, 13 carefully selected female patients with neurogenic bladders and incontinence refractory to other conservative therapy (9 patients) or deteriorating upper urinary tracts (4 patients) underwent anterior urethral transposition. Followup averaging 6 years revealed minimal stomal problems and excellent preservation of renal function. The surgical technique with modifications is presented.

Adolescent↗
PubMed2004

The outcome of detrusor myotomy in children with neurogenic bladder dysfunction.

PURPOSE: We evaluate the outcome of detrusor myotomy for neurogenic bladder dysfunction (NBD) in children. MATERIALS AND METHODS: A retrospective analysis was performed of data compiled from medical and urodynamic records of children younger than 16 years with NBD who had undergone detrusor myotomy from 1992 to 2000 at our department. RESULTS: Surgery was performed in 14 children with a mean age +/- SD of 6.7 +/- 4.3 years (range 0.9 to 14.2) and mean followup of 5.9 +/- 1.7 years. All patients were diagnosed with NBD, which was the result of myelomeningocele in 9, sacral agenesis in 2, lumbosacral lipoma in 1, multiple vertebral anomalies in 1 and spinal neuroblastoma in 1. Main indications for surgery included urinary incontinence in 11 cases and high pressure/low capacity bladders with vesicoureteral reflux and impending renal damage in 8. No major postoperative complications were recorded. Although mean maximal cystometric bladder capacity was unchanged 1 month postoperatively (89.7 +/- 70.6 ml) compared to preoperatively (92.5 +/- 75.1 ml, p = 0.87), significant increments of 216%, 237% and 292% were measurable at 3 months, 1 year and 5 years, respectively. Ultimately most of the patients approached age specific capacities. Complete continence on clean intermittent catheterization was achieved by 8 of 11 patients and improved markedly in 1. Reflux was alleviated in 6 cases and improved in 1. Kidney function developed normally in all but 1 patient with persistent reflux. CONCLUSIONS: When feasible, detrusor myotomy offers a safe and effective alternative for the management of pharmacologically intractable NBD in children.

Adolescent↗