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PubMed1978

[Bladder neck urethral obstructions of neurogenic bladder in children (author's transl)].

The study of 62 bladder neck and urethral obstructions among 210 neurogenic bladder in children, allow to give an urologic definition, corroborated by urodynamic exploration.--28 boys show lesions of external sphincer as described in traumatic paraplegia in adult. The treatment in external sphincterotomy: by perineal approach (5 cases : 1 success--4 failures), or retropubic (3 cases : 2 successes--1 failure) and mainly endoscopic (12 successes over 21 primary resections, and 8 successes over 10 repeated interventions). The results are given according to the obstruction, the continence and urinary upper tract. Ureteroneocystostomy il allowed by obstruction release. The pathogeny of obstruction is discussed according to the paralysis of the sphincter, as well as the therapy with the comparison between sphincterotomy and self-catheterism.--34 girls present 3 kinds of obstruction;--bladder neck dysectasia (5 cases) with obvious radiologic findings: YV plasty was done with in 2 cases ureteroneocystostomy;--posterior downfall of the bladder where intermittent catheterization provides excellent results;--pure urethral obstruction is also observed, like in boy's external sphincter lesion. Various types of therapy are discussed, specialy TV plasty extented to the urethral meatus, but in girls the intermittent catheterization which respects continence and which can be associated to an ureteroneocystostomy or a pharmacologic therapy is at present the most appropriate method.

Adolescent↗
PubMed2001

Fecal and urinary continence after ileal cecal cystoplasty for the neurogenic bladder.

PURPOSE: In patients with a neurogenic bladder augmentation with the ileal cecal segment has generally been disregarded as an option due to concerns regarding fecal incontinence. We report our results using a hemi-Indiana pouch bladder augmentation for neurogenic bladder. MATERIALS AND METHODS: A review of 63 patients with neurogenic bladder dysfunction treated with a hemi-Indiana pouch bladder augmentation was performed. None of the patients had fecal incontinence before surgery. RESULTS: Median followup interval was 6 years (range 1 to 10). Etiology of the neurogenic bladder was spinal cord injury in 42 patients (66%), myelodysplasia in 18 (29%) and sacral agenesis in 3 (5%). One patient (1.5%) died immediately postoperatively from a pulmonary embolus. Of the remaining 62 patients, urinary continence was achieved in 54 (87%) and 8 were incontinent per the abdominal stoma. All 8 patients were treated with Contigen injections into the stoma and 4 (50%) became continent. The 4 patients with persistent urinary incontinence became continent after open surgical revision. Postoperatively, fecal continence was improved in 14 patients (23%), unchanged in 46 (74%) and worse in 2 (3%). In 2 patients with deterioration in bowel function stool frequency and fecal soilage increased in conjunction with antibiotic usage. No patient had chronic fecal incontinence. CONCLUSIONS: In select patients with neurogenic bladder dysfunction ileal cecal bladder augmentation with a continent tapered ileal limb results in a 100% incidence of urinary continence with minimal alterations in fecal continence.

Cecum↗
PubMed1993

[Spontaneous bladder perforation--a rare complication of neurogenic bladder dysfunction].

Spontaneous rupture of the urinary bladder which is not associated with trauma is uncommon. A case of spontaneous bladder perforation (triggered by an episode of urinary retention) and peritonitis in a 69-year old male patient with neurogenic bladder dysfunction is reported. The latter was due to disseminated sclerosis and was complicated by recurrent urinary tract infection and two bladder calculi. The etiology, diagnosis and treatment of spontaneous bladder perforation is briefly discussed. The diagnosis spontaneous bladder perforation should be considered in patients with non-characteristic acute abdominal conditions and voiding symptoms, especially if they have neurogenic bladder dysfunction and a history of recurrent lower urinary tract infections and/or bladder calculi. We recommend that bladder stones should be removed--also in asymptomatic cases.

Abdomen, Acute↗
PubMed2000

Familial mitochondrial intestinal pseudo-obstruction and neurogenic bladder.

Intestinal dysmotility and neurogenic bladder have been described as part of two autosomal-recessive mitochondrial disorders assumed to be due to a defect in communication between the nuclear and mitochondrial genomes: myoneurogastrointestinal encephalopathy (MNGIE) and diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (Wolfram syndrome). Partial cytochrome c oxidase deficiency has been described in both. We describe three Ashkenazi Jewish siblings with progressive intestinal dysmotility, neurogenic bladder, and autonomic manifestations but no central nervous system involvement. Cytochrome c oxidase deficiency was demonstrated in peripheral and multiple intestinal muscle biopsies. Mitochondrial DNA analysis of an intestinal biopsy of patient 1 showed heteroplasmy consisting of a normal 16.5-kb band and an approximately 28-kb band, suggestive of a duplication. Mitochondrial DNA analysis of a muscle biopsy of patient 2 showed multiple deletions, mainly 10- and 11-kb bands. We suggest that this unique combination of intestinal pseudo-obstruction and neurogenic bladder could comprise a new autosomal-recessive mitochondrial disorder.

Adolescent↗
PubMed1996

[Usefulness of bladder auto-augmentation in neurogenic bladder: a case report].

A 41-year-old male with myelomenigocele underwent a bladder auto-augmentation and endoscopic collagen injections. He has been performing self intermittent catheterization for 10 years but urinary incontinence remained unchanged. Furthermore, he suffered from recurrent pyelonephritis due to the left vesicoureteral reflux. A preoperative fluoroscopic urodynamic study showed a poorly compliant bladder with the maximal bladder capacity of 200 ml at 60 cmH2O. The left vesicoureteral reflux was observed at 10 cmH2O. The low compliant bladder was treated with the bladder autoaugmentation and the left vesicoureteral reflux was treated with the endoscopic subureteral injection of collagen 5 months after the previous operation. A fluoroscopic urodynamic study 6 months postoperatively showed the increase of the maximal bladder capacity of 300 ml at 18 cmH2O and the reflux disappeared completely. The endoscopic periurethral injections of collagen improved his persisting urinary incontinence. In patient with neurogenic bladder having a lot of clinical problems, bladder auto-augmentation is less invasive and offers many advantages over enterocystoplasy.

Adult↗
PubMed2000

Urinary diversion and orthotopic bladder substitution in children and young adults with neurogenic bladder: a safe option for treatment?

PURPOSE: Combined pharmacotherapy, clean intermittent catheterization and infection prophylaxis is currently the gold standard of treatment for neurogenic bladder. However, as the adolescent gains independence from parental supervision, the intervals of clean intermittent catheterization compliance with medical treatment and regularity of followup examinations may decrease, and neurological and/or orthopedic status may change. This situation sometimes leads to failure of conservative treatment, resulting in incontinence and/or deterioration of the upper urinary tract. A multidisciplinary team was established at our institution 30 years ago to assess all aspects of care for patients with neurogenic bladder, of which urological function is just 1 aspect of the complex problem. Patient desires and essential medical goals, such as preservation of renal function, are considered by this team. An adequate compromise is sought and achieved in some cases by urinary diversion. We investigated the long-term safety of urinary diversion in these patients and its ability to protect the upper urinary tract. MATERIALS AND METHODS: Between 1967 and 1997 urinary diversion was performed in 149 patients with neurogenic bladder. Mean followup was 11.8 years (range 0.8 to 28.5) in 129 cases. Mean patient age at surgery was 12.1 years (range 0.8 to 20). A colonic conduit was created in 59 patients, mainly before the era of clean intermittent catheterization and continent diversion, while orthotopic bladder substitution was performed in 12 and continent urinary diversion (Mainz pouch I) in 58, of whom 50% were wheelchair bound. RESULTS: The upper urinary tract improved or remained stable in 97% of the renal units in patients with a colonic conduit or Mainz pouch I, and in 95% of the renal units in those with orthotopic bladder substitution. All patients with bladder substitution were continent during the day, 1 required occasional pads at night and 7 of 12 performed clean intermittent catheterization. Complete continence was achieved in 98% of those with a continent stoma. CONCLUSIONS: After failure of conservative treatment in patients with neurogenic bladder urinary diversion represents a safe long-term compromise. Daytime and nighttime continence is provided by the Mainz pouch bladder substitution and urinary diversion, while the upper urinary tract is protected by antireflux ureteral implantation.

Adolescent↗
PubMed1993

Urodynamic evaluation in pediatric neurogenic bladder.

Urodynamic evaluation in pediatric neurogenic bladder is prerequisite for accurate prediction of prognosis and selection of appropriate treatment modality. We classified normal, hyperreflexic and areflexic bladders by cystometry. Hyperreflexic bladder was subdivided into two groups with or without detrusor sphincter dyssynergia and areflexic bladder into low pressure and high pressure. Among 36 patients with myelodysplasia on whom we performed a videourodynamic study vesicoureteral reflux was found in three of 7 patients with hyperreflexia with detrusor sphincter dyssynergia, two of 6 patients with hyperreflexia without detrusor sphincter dyssynergia and five of 10 patients with areflexia with high pressure. Low pressure areflexic bladder didn't show vesicoureteral reflux. When we evaluated 39 pediatric neurogenic bladder patients with a mean 25.5 follow-up months period, upper tract deterioration was improved and normal findings persisted in all the compliant patients to treatment. In the noncompliant group initial abnormal upper tract findings persisted or aggravated, especially in hyperreflexic bladder with dyssynergia and high pressure areflexic bladder. One of the three hyperreflexic bladders with dyssynergia and two of six high pressure areflexic bladders received augmented cystoplasty. These data show that urodynamic evaluation in pediatric neurogenic bladder provides excellent criteria for selecting high risk groups in pediatric neurogenic bladder.

Adolescent↗
PubMed2000

Recent advances in the management of the neurogenic bladder.

Proper evaluation of the neurogenic bladder remains the cornerstone for accurate management of the neurologically impaired patient. Due to the inherent progressive nature of many neurologic disorders causing bladder dysfunction and lack of targeted medical therapy, much work has been done and needs to be done to advance the management of this often-difficult patient population. This article reviews the latest advances in managing the neurogenic bladder. For ease of review, the neurogenic bladder can be divided into 2 basic categories: first, bladders that fail to empty successfully and, second, those that fail to store urine adequately. Therapy should be based on these categories because poor therapeutic results are seen when a standard treatment is prescribed for the wrong bladder condition. Given the success of other specialties (physical medicine and rehabilitation, orthopedics, and neurology) at improving and prolonging the lives of the neurologically impaired patient, the urologist has an increasing responsibility to evaluate and treat the neurogenic bladder effectively over a life span that is approaching that of the normal population.

Anastomosis, Surgical↗
PubMed2003

Botulinum-a toxin detrusor injection as a novel approach in the treatment of bladder spasticity in children with neurogenic bladder.

OBJECTIVES: Children with neurogenic hyper-reflexive bladder in whom classical therapy with anticholinergic drugs and intermittent catheterization fails are threatened by high intravesical pressure, vesicoureteral reflux, and impairment of kidney function. Surgery, such as bladder augmentation, is often necessary in such cases. To obviate surgery in these high-risk children, we investigated the use of detrusor injection of botulinum-A toxin (Botox). METHODS: Our subjects were 20 children with hyper-reflexive detrusor muscle and high bladder pressure, over 40 cmH(2)O despite anticholinergic therapy. After baseline urodynamic measurements, we injected botulinum-A toxin into the detrusor muscle at 30-50 sites at 12 U/kg of body weight up to a maximum of 300 U. Follow-up cystometric measurements were taken two to four weeks and three and six months after injection. RESULTS: From basic measurements to follow-up cystometry, mean reflex volume changed from 97.1 ml before injection to 178.6 ml after four weeks (p<0.01) and to 162.8 ml after three months (p<0.01). After six months mean reflex volume returned to 119.3 ml (n.s.). Maximal bladder capacity changed from 163.1 ml to 219.9 ml (p<0.01), to 200.6 ml (p<0.01) and to 222.4 ml (p<0.01), respectively, and maximal detrusor pressure changed from 59.6 cmH(2)O to 34.9 cmH(2)O (p<0.01), to 46.7 cmH(2)O (n.s.) and to 61.8 cmH(2)O (n.s.), respectively. CONCLUSION: Botulinum-A toxin (Botox) is effective when injected into the hyper-reflexive detrusor muscle. It is a valuable treatment option in the management of neurogenic bladder. The effect lasts about six months, and then reinjection is necessary.

Adolescent↗
PubMed1997

[Transvaginal closure of the bladder neck in women with a neurogenic bladder and destroyed urethra].

Complete destruction of the urethra is one of the long-term complications of continuous bladder catheterization in women with advanced neurogenic bladder, resulting in a continuous urine leak around the catheter. This type of incontinence can be treated by closure of the bladder neck associated with suprapubic bladder drainage. Several approaches hve been proposed: abdominal, vaginal and mixed abdominal-vaginal. Each of these techniques is described, together with their results. Closure of the bladder neck decreases the nursing care, reduces the risk of perineal infectious and cutaneous complications and improves the patient's quality of life. Ileal urinary diversion is not always possible in these patients who often have a poor general status. Transvaginal closure of the bladder neck therefore constitutes one of the treatment options.

Female↗
PubMed1980

Urinary tract undiversion in a patient with an areflexic neurogenic bladder: management with intermittent catheterization.

Neurogenic bladder disease generally is though to be a contraindication to urinary undiversion. We describe a teenage boy who received an ileal conduit for an areflexic neurogenic bladder. He had a poor emotional reaction to the diversion and requested reconstruction. After extensive studies undiversion was done. The neurogenic bladder has been managed with intermittent catheterization. Thus far, the result has been quite satisfactory.

Adolescent↗
PubMed2000

Expression of virulence factors among Escherichia coli isolated from the periurethra and urine of children with neurogenic bladder on intermittent catheterization.

BACKGROUND: Patients with neurogenic bladder caused by spinal cord injury or myelomeningocele empty their bladder several times a day by intermittent catheterization. Bacteriuria without symptoms of infection is frequently present in these patients. Occasionally a clone of Escherichia coli that has been carried for weeks without symptoms causes a symptomatic urinary tract infection. Virulence factors are commonly expressed among E. coli causing infection in patients with normal urinary tracts. However, it is unknown whether expression of virulence factors by an E. coli clone colonizing the neurogenic bladder increases the risk of subsequent infection. In this study we examined the prevalence of virulence factor expression among E. coli isolated from the periurethra and urine of patients with neurogenic bladder. METHODS: The prevalence of virulence factors was examined among E. coli isolated from the periurethra and urine in patients with neurogenic bladder who received intermittent catheterization and were followed for 6 months. Representative isolates from the 37 clonal types of E. coli detected in the periurethra and urine of children with neurogenic bladder were assessed for O antigen, hemolysin, aerobactin, serum resistance and type I and P-adhesin. RESULTS: All clones were serum-resistant and expressed type I adhesin, none expressed aerobactin and two expressed hemolysin. The presence of P-adhesin was not unique to clones associated with symptomatic infection. The presence of P-adhesin carried for weeks in a clone did not predict subsequent infection in the neurogenic bladder. CONCLUSION: Bacterial virulence factors did not predict infection of the neurogenic bladder.

Adolescent↗
PubMed1999

[A case of systemic lupus erythematosus (SLE) with a neurogenic bladder, successful treatment with intravenous cyclophosphamide pulse therapy].

A 46-year-old woman was diagnosed as having systemic lupus erythematosus (SLE) in 1990 and was treated with a daily maintenance dose of prednisolone (PSL). She suddenly developed urinary incontinence with a high grade fever and erythema of the arms and legs on May 10, 1998 and was admitted to our hospital. Laboratory findings on admission showed proteinuria, pancytopenia and hypocomplementemia. Anti-nuclear antibody, anti-DNA antibody and anti-Sm antibody were positive. Ultra-sonography after urination revealed dilatation of the bladder. Cystometrography showed an autonomous neurogenic bladder. The diagnosis of neurogenic bladder complicated by peripheral neurone disturbance associated with recurrence of SLE was made and intravenous methylprednisolone (m-PSL) pulse therapy (1000 mg/day) was initially administered for 3 days followed by 60 mg of daily per os PSL. Urinary incontinence did not improved. The same therapy was conducted 3 times with no response. Therefore, treatment was started with intravenous cyclophosphamide pulse therapy (500 mg/day) which resulted in marked improvement of urinary incontinence, hypocomplementemia, proteinuria and pancytopenia. This case developed a neurogenic bladder caused by lower neurone disturbance but did not show central nervous system lupus with upper neurone disturbance. Neurogenic bladder caused by lower neurone disturbance in SLE has rarely been reported. The vasculitis of SLE was probably responsible for this neuropathy and this case was successfully treated with intravenous cyclophosphamide pulse therapy.

Cyclophosphamide↗
PubMed2000

[Bulbocavernosus reflex induced by bladder filling in a neurogenic bladder patient due to spinal arteriovenous malformation. A case report].

A 59-year-old man with spinal arteriovenous malformation at L-1 level was referred to our clinic for urinary retardation and urinary protraction. Bulbocavernosus reflex (BCR) was performed at empty bladder and at the storage phase during cystometry. BCR was evoked by compressing the glans penis. The evoked reflexes were examined by palpatating the contractile responses of the bulbocavernosus muscle and bipolar surface electrodes on each side of para-perineal raphe. Evoked response of BCR couldn't be detected at empty bladder, but obvious responses of BCR were detected at about 300 ml bladder filled. For further evaluation, a concentric needle electrode was inserted into the periurethral striated muscle to examine the evoked potential of BCR. The responses were unstable at empty bladder, but stable evoked potentials were obtained at storage phase. BCR performed only at empty bladder may cause false negative result.

Arteriovenous Malformations↗