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At least 361 records · Page 20Linked to original sources
PubMed2006

Repeated intradetrusor botulinum toxin type A in children with neurogenic bladder due to myelomeningocele.

PURPOSE: We evaluated the effect of repeated intradetrusor injections of BTA in pediatric myelomeningocele not responding to medical management. MATERIALS AND METHODS: After baseline history, physical examination and urodynamic assessment BTA was injected (5 IU/kg body weight, maximum 300 IU) at 10 to 30 sites. Clinical and urodynamic assessment was performed at 3 months after each injection. Re-treatment was offered when clinical symptoms returned. RESULTS: A total of 20 patients (average age 13 years) received BTA injections. Of the patients 13 became continent. MBC increased from 215.6 +/- 58.8 cc to 338.3 +/- 98.4 cc (p < 0.01), MDP decreased from 43 +/- 13.7 cm H2O to 21.6 +/- 10.5 cm H2O (p < 0.01) and compliance increased from 5.2 +/- 2.6 ml/cm H2O to 13 +/- 6.9 ml/cm H2O (p < 0.01). At an average of 8.1 months after the first injection all 13 patients received a second injection, which led to similar improvement, ie MBC increased from 200.5 +/- 41.6 cc to 404.2 +/- 57.8 cc (p < 0.001), MDP decreased from 48.18 +/- 6.1 cm H2O to 27.8 +/- 3.7 cm H2O (p < 0.01) and compliance increased from 6.0 +/- 3.1 ml/cm H2O to 15.1 +/- 5.2 ml/cm H2O (p < 0.01). Among the responders 3 received 3 injections and 1 received 4 injections, all of whom exhibited improvement similar to that seen initially. Among our initial cohort of 20 patients 7 failed to improve initially and 6 failed to improve after a second injection. CONCLUSIONS: BTA seems to be a simple and safe way to postpone or avoid invasive procedures in two thirds of children with myelomeningocele not responding to usual medical treatment.

Adolescent↗
PubMed1993

Synchronous cystoscopy and cystometry in the management of neurogenic bladder dysfunction.

The physical difficulties associated with cystoscopy and cystometry in the spinal cord injury patient led to a clinical trial of synchronous cystoscopy and cystometry in these individuals. Following a disappointing experience with external transducer methodology, a recently available fiberoptic microtransducer system was used and an effective system was developed. A total of 20 individuals with spinal cord injury underwent a standard water cystometrogram on an examination table followed by synchronous flexible cystoscopy and cystometry using a 5F fiberoptic microtransducer while seated in a chair. The results showed both pressure tracings to be clinically identical. Uninhibited contraction spikes, compliance curves and leak point pressures were essentially the same by both methods and artifact was not a problem. Given the speed, ease and reproducibility of this method, the difficulties with patient transfer for these studies have been virtually eliminated. Two urethral instrumentations have been replaced by 1. Examination room time was decreased from 60 to approximately 10 to 15 minutes with half of the required personnel. Perhaps more importantly, these occasionally problematic individuals clearly prefer this streamlined approach and patient compliance with followup has improved.

Cystoscopes↗
PubMed1988

The prophylactic use of clean intermittent catheterization in the treatment of infants and young children with myelomeningocele and neurogenic bladder dysfunction.

To examine the hypothesis that the prophylactic use of clean intermittent catheterization can prevent urinary tract deterioration in infants and young children with myelomeningocele a prospective controlled study was performed on 24 patients. Preliminary results indicate that more than 50 per cent of the patients with bladder sphincter incoordination managed by self-voiding had urinary tract deterioration. In contrast, in only 10 per cent of the patients treated prophylactically with clean intermittent catheterization did deterioration occur. We conclude that when bladder sphincter incoordination is diagnosed in children with myelomeningocele they are at a high risk for the development of future urinary tract injury. The prophylactic use of clean intermittent catheterization can actually prevent this deterioration and its use in this manner is recommended.

Age Factors↗
PubMed1986

Sphincterotomy failure in neurogenic bladder disease.

Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.

Adult↗
PubMed1984

Urodynamic studies in enuresis and the nonneurogenic neurogenic bladder.

We studied urodynamically 55 patients with enuresis. The severity of urinary incontinence ranged from occasional nocturnal episodes to daytime and nighttime wetting associated with radiographic abnormalities of the bladder and upper urinary tract. Despite differences in symptoms, urodynamic findings of poor cerebral appreciation of the degree of bladder filling and sudden unanticipated detrusor contractility were common in 50 of the 55 patients. Volitional detrusor sphincter discoordination also was common and appeared to be related to uncontrolled bladder contractility rather than a primary problem.

Adolescent↗
PubMed1982

Role of striated and smooth muscle components in the urethral pressure profile in traumatic neurogenic bladders: a neuropharmacological and urodynamic study. Preliminary report.

Urodynamic investigations with urethral pressure profile, and vesical, intrarectal and anal pressure recordings were performed in 37 patients with spinal cord lesions. The recordings were done before and after phentolamine injections and/or pudendal nerve blocks to evaluate the respective contribution of sympathetic and somatic innervation to the maximum urethral closure pressure in the mid and distal portions of the membranous urethra. A pressure gradient was demonstrated in the membranous urethra with higher values in the distal than in the mid portion. These results emphasize that the interrupted withdrawal technique is superior to the continuous technique in patients with upper motor neuron bladders. Mid urethral striated and smooth muscle components were shown to represent approximately 60 and 30 per cent of the maximum urethral closure pressure, respectively. In the distal urethra striated and smooth components are more abundant than in the mid portion and contribute in equal proportion to the maximum urethral closure pressure. No substantial role was found for the vascular bed in the maximum urethral closure pressure. The greatest pressure decrease in the mid and distal urethra of patients with lower motor neuron bladders was believed to be an effect of denervation supersensitivity. The results of pudendal blocks showed sphincter dyssynergia to be mediated through pudendal nerves via spinal reflex arcs. Phentolamine effects on bladder activity suggest that blockade of alpha-adrenergic receptors inhibits primarily the transmission in vesical and/or pelvic parasympathetic ganglia and acts secondarily through direct depression of the vesical smooth muscle. Our neuropharmacological results raise strong doubts as to the existence of a sympathetic innervation of the striated urethral muscle in humans.

Adrenergic alpha-Antagonists↗
PubMed1980

Prophylaxis of bacteriuria during intermittent catheterization of the acute neurogenic bladder.

A randomized prospective study of bacteriuria control during early intermittent bladder catheterization was performed on a spinal cord injury service. The 64 male subjects underwent 16,620 catheterizations and had 83 significant episodes of infection. The infection rates among various groups were compared: 1) control patients, 2) patients treated with intravesical neomycin/polymyxin-B, 3) patients given low dose daily macrocrystals of nitrofurantoin and 4) patients given intravesical treatment and oral nitrofurantoin. There was significant reduction in infection rates when oral and intravesical antibiotics were used.

Acute Disease↗
PubMed1979

Neurogenic bladder and the tethered spinal cord syndrome.

We report 2 cases of the tethered spinal cord syndrome. Early clinical detection of this syndrome in children with bladder dysfunction should be followed by diagnostic myelography and immediate surgical release of the spinal cord. The pathophysiology of the syndrome is discussed.

Child↗
PubMed1978

Neurogenic bladder in the woman with multiple sclerosis.

Fifty women with proved multiple sclerosis were grouped according to the severity of the disease (measured urodynamically) and followed for 5 years. All patients were asymptomatic initially. The symptoms, urodynamic results and therapy are discussed. As the disease progresses in a stepwise fashion bladder symptoms become more pronounced. With current methods of treatment and followup better control of the symptoms can be expected.

Adult↗