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Teaching self-catheterization skills to children with neurogenic bladder complications.

We examined the effects of simulation training on the acquisition of self-catheterization skills in 2 female children with spina bifida. Based on a task analysis, the children were taught to perform on a doll each of the components of preparation, and, using a mirror to locate the urinary meatus, to insert and remove the catheter and to clean-up. Before, during, and after training, the children's performance of the skills on the doll and on themselves was assessed. Results of a multiple baseline design across subjects and skill components showed that doll training facilitated the children's acquisition of self-catheterization skills.

Behavior Therapy↗

Influence of atropine and isoprenaline on detrusor hyperactivity in children with neurogenic bladder.

Bladder hyperactivity defined as unconscious, involuntary detrusor contractions giving rise to intravesical pressure increase of at least 15 cm H2O and of minimum 15 sec duration, has been examined in 9 children with myelodysplasia and incontinence. The effect of atropine and isoprenaline on the hyperactivity pattern was evaluated. Atropine had a dose-related inhibiting influence on both frequency and amplitude of detrusor contractions whereas isoprenaline was without these favourable effects.

Adolescent↗

Continence training of children with neurogenic bladder and detrusor hyperactivity: effect of atropine.

Recording of the intravesical pressure throughout the filling phase in children with low lumbar and high sacral levels of myelodysplasia showed detrusor hyperactivity which could be inhibited by anticholinergic medication in a dose-dependent manner under experimental conditions. Atropine as treatment for urinary incontinence during everyday activity was remarkably effective when given parenterally. Orally administered atropine was associated with 50-100% improvement of incontinence in six of 9 patients and 35-45% in the remaining three patients. Successful treatment with anticholinergic drugs requires careful selection of patients, including recording of the filling-phase intravesical pressure. Only in patients with detrusor hyperactivity is a good result of such treatment to be expected.

Adolescent↗

Electrovesicogram in the neurogenic bladder.

The vesical electric activity was studied by electrovesicogram (EVG) in 24 patients with spinal cord injury: 15 with upper (UMNL) and 9 with lower (LMNL) motor neuron lesion. Mean age was 48.3 years; 16 were men and 8 were women. Eight healthy volunteers acted as controls. Transcutaneous recording was done with both a full and empty urinary bladder. three electrodes were applied supra-pubically and one reference electrode was applied to the lower limb. The normal volunteers recorded regular triphasic pacesetter potentials (PPs), which were reproducible in the individual subject. The electrovesicographic pattern was similar in the full and empty bladder, except that the PPs of the latter had a lower amplitude. the patients with UMNL showed "dysrhythmic" pattern with irregular rhythm, amplitude, and frequency in both the full and empty urinary bladder. Patients with LMNL exhibited "silent" EVG. The results indicate that electrovesicography could be used as an investigative tool that may help in the diagnosis of such conditions. The technique is simple, easy, noninvasive, and without complications.

Adult↗