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At least 307 records · Page 17Linked to original sources
PubMed1992

Reconstruction of the lower urinary tract for neurogenic bladder: lessons from the adolescent age group.

Of 42 adolescents with neurogenic bladder who presented for lower urinary tract reconstruction, 4 patients with severe spina bifida were unfit for major surgery. Five patients had a simple undiversion; 4 of these had a poor outcome because of unpredicted sphincter incontinence (1 patient) or instability (3). A total of 26 patients had an enterocystoplasty. All 7 patients who had a substitution cystoplasty had a good result, as did 3 males with a clam cystoplasty. Nine of 16 females had a poor result from a clam procedure. In 3 the problem lay with self-catheterisation difficulties. One each had persistent hyper-reflexia and sphincter incontinence. Four had hyper-reflexia on sexual intercourse. Overall, 42% of females had problems from the retained bladder segment. Seven patients had continent urinary diversions. The results were good, although 2 Kock nipples required revision. Surgery was well tolerated. There was a 21% re-operation rate for complications. Pre-operative investigation correctly predicted sphincter competence and the need for self-catheterisation in 79 and 86% respectively.

Adolescent↗
PubMed1980

Cutaneous transureteroureterostomy in children with neurogenic bladders.

Our experience with 30 cutaneous transureteroureterostomies performed in children with neurogenic bladders is presented. 14 of them have been followed up for more than 5 years. The procedure is very simple and has a low percentage of immediate and late complications. Some premises to be followed regarding surgical technique in order to obtain the best possible results are emphasized.

Child, Preschool↗
PubMed1989

[Neurogenic bladder dysfunction due to tethered spinal cord syndrome in adults: report of two cases].

Two cases of neurogenic bladder dysfunction due to tethered spinal cord syndrome in adults were experienced. They visited our hospital with the complaint of dysuria. The excretory urogram were almost normal. Urodynamic examinations revealed normoactive detrusor-overactive sphincter in case 1, and overactive detrusor-overactive sphincter in case 2. Cystometry-electromyogram demonstrated detrusor-external urethral sphincter dyssynergia in either cases. They were diagnosed as neurogenic bladder due to intraspinal tumor with spina bifida by myelography, computed tomography, and urodynamic examination. Laminectomy, subtotal extirpation of tumor and neurectomy of filum terminale were performed by orthopedists in both cases. The tumor was pathologically diagnosed as lipomas. Postoperatively they showed satisfactory recovery in micturition.

Adult↗
PubMed1983

Augmentation cystoplasty in the treatment of neurogenic bladder dysfunction.

We report on the role of augmentation cystoplasty in the treatment of 18 patients with neurogenic bladder dysfunction and associated symptoms of severe urinary urgency, frequency and urinary incontinence. All patients failed to obtain any symptomatic improvement with a variety of treatments, including intermittent self-catheterization and pharmacologic manipulation. Preoperative evaluation helped segregate the patients into 3 groups: 1) those with extremely poor bladder wall compliance, 2) those with severe detrusor hyperreflexia and 3) those with a combined problem of poor bladder wall compliance and hyperreflexia. Bladder augmentation involved cecocystoplasty in 15 cases and ileocystoplasty in 3. In 5 patients an artificial urinary sphincter cuff was placed in an attempt to improve continence. Followup ranging from 12 to 120 months (mean 38 months) was available in 17 patients. An excellent surgical result was obtained in 82 per cent of the patients who became asymptomatic and continent after augmentation cystoplasty. Augmentation cystoplasty is a therapeutic modality that should be considered a viable treatment option in selected patients with neurogenic bladder dysfunction.

Adolescent↗
PubMed1990

Management of neurogenic bladder dysfunction secondary to myelomeningocele.

We investigated 55 children, aged from 24 months to 14 years with neurogenic bladder dysfunction secondary to myelomeningocele, by serial urodynamic. They were serially evaluation over 2-5 years. Management consisted of drug therapy together with intermittent vesical catheterization in different combinations on the basis of initial urodynamic assessment. In 5 children with a hypotonic sphincter, it was necessary to implant an artificial sphincter. With this regimen control or frank improvement of micturition was achieved in 53 patients, urodynamic function became normal or improved in 54, and recurrent urinary tract infections persisted only in 5 patients. In the light of these results, we believe that treatment of the neurogenic bladder secondary to myelomeningocele should be determined by initial urodynamic evaluation.

Adolescent↗
PubMed2002

Alfuzosin in the treatment of high leak-point pressure in children with neurogenic bladder.

OBJECTIVE: To decrease the detrusor leak-point pressure (LPP) of > 40 cmH2O in children with a neurogenic bladder, using the alpha1-adrenergic blocking agent alfuzosin. PATIENTS AND METHODS: Videocystometry was used to measure the detrusor LPP and several other variables before and 3 weeks after the oral administration of alfuzosin (2.5-7.5 mg/day) in 17 children (mean age 6.3 years) with an upper motor neurone lesion. RESULTS: The mean (sd) detrusor LPP decreased from 68 (37) to 46 (31) cmH2O (P < 0.01), reflex volume (defined as the volume at the first uninhibited bladder contraction of > 15 cmH2O) increased from 78 (69) to 112 (118) mL (+ 44%), bladder compliance increased from 9.3 (6.1) to 19.6 (14.6) mL/cmH2O (+ 111%), maximal vesical pressure decreased from 84 (40) to 70 (47) cmH2O (- 17%), and the mean number of uninhibited bladder contractions decreased from 6.3 to 3.5 (- 44%). The therapy was well tolerated; side-effects were rare and not severe. Intermittent catheterization could be avoided in six children. CONCLUSION: Alfuzosin decreases the detrusor LPP in children with a neurogenic bladder caused by an upper motor neurone lesion, significantly and therapeutically, and should be considered as an alternative or addition to intermittent catheterization and anticholinergic drugs in selected patients.

Adolescent↗
PubMed2006

Improving the global management of the neurogenic bladder patient: part II. Future treatment strategies.

BACKGROUND: Patients with neurogenic bladder represent a small fraction of the total overactive bladder population. As a consequence, development of new therapies in this area has largely focused on idiopathic urinary incontinence. The absence of data for patients with neurological disease has far-reaching implications, affecting reimbursement and physicians' willingness to prescribe therapies, and limiting access of potential valuable treatments to patients whose lives are significantly impaired by inadequately managed bladder symptoms. SCOPE: The range of new therapies is increasing. Although many reviews of the overall safety, efficacy and mode of action of such treatments are available, there is limited information on how these treatments will best be used in clinical practice. We considered the current benefits and limitations of the various new licensed and unlicensed therapies and what role each would have in the future management of neurogenic urinary incontinence. CONCLUSIONS: A wide range of new treatments have been investigated for the management of overactive bladder; few, however, have been evaluated extensively in neurogenic urinary incontinence. Further studies are required to determine the optimal dosing regimes and formulations for individual sub-populations of neurogenic bladder patients and to determine the cost-effectiveness of these interventions. With the current experience available, two treatment algorithms for a subset of patients with neurological disease have also been proposed, which suggest at which stage of management and in which patients individual therapies for neurogenic urinary incontinence could be used.

Algorithms↗
PubMed2004

Mast cell chymase is a possible mediator of neurogenic bladder fibrosis.

AIMS: Urinary bladders of patients with myelomeningocele, owing to spina bifida, are often functionally impaired, fibrotic organs. Common to this condition are repeated occurrences of bladder infection and inflammation. Since mast cells have been associated with a fibrogenic response in inflammatory conditions, we investigated the role of mast cell granule product, chymase, as a mediator of myleodysplastic bladder fibrosis. METHODS: Human control and myelodysplastic bladder tissues were stained with Unna's stain and chymase antibody to determine mast cell number and localization. Cell specific localization of collagen mRNAs was determined by in situ hybridization (ISH). In vitro, normal human bladder fibroblasts were treated with recombinant chymase, heparin and inhibitors, and collagen subtype concentration was determined by enzyme linked immunosorbent assay (ELISA). RESULTS: Myelodysplastic bladders were characterized by increased mast cells in the detrusor muscle layer compared to control bladders, as well as mast cell degranulation and increased connective tissue deposition. Both types I and III collagen mRNA localized to fibroblasts surrounding detrusor muscle fascicles, whereas only collagen III mRNA localized to cells within connective tissue infiltrated muscle bundles in myelomeningocele bladder tissue. Chymase treatment of bladder fibroblasts, in vitro, was dose-dependent and resulted in significant increases in both types I and III collagen. Heparin did not alter collagen protein expression, whereas heparin-chymase combination modulated type III collagen expression. Serine protease inhibitor, phenylmethylsulfonlyfluoride, did not inhibit collagen synthesis, whereas denatured chymase resulted in decreased collagenous protein levels. CONCLUSIONS: Bladder fibrosis may be mediated by mast cell chymase stimulation of collagen synthesis.

Adolescent↗
PubMed1987

A critical reappraisal of cystometry in neurogenic bladder diseases.

Repeated cystometry was performed over an eight hour period in 14 patients with detrusor hyperreflexia. Volumes at first contraction, and at bladder capacity and also bladder compliance showed significant differences within individual variances and an increase in standard deviation in relation to increase in mean value. Amplitude of contractions showed equal variances in all patients. After a logarithmic transformation of the measurements the volume at first bladder contraction showed a significant increase (p less than 0.02) from the first to the second investigation performed an hour later. Determination of sample size in clinical trials using the pooled estimate of the standard deviations is discussed.

Adolescent↗