[Efficacy of spinal neurostimulation in the treatment of neurogenic bladder].
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Repeated catheterisation and drugs with a pharmacodynamic action are not always able to ensure perfect continence in children with meningomyeloceles. To treat uncontrollable incontinence, the authors propose an aponeurotic suspension of the bladder neck as described by Goebbel-Stoeckel in order to increase the peripheral resistance. At the same time, sufficient bladder compliance can also be obtained either by means of pharmacodynamic treatment or by enlargement enterocystoplasty. The aim is to obtain catheterisation every 4 to 6 hours without any incontinence. Young girls constitute the ideal indication for this programme as catheterisation is safe and easily accepted. Ten girls underwent Goebbel-Stoeckel operation, associated with sigmoido-cystoplasty in 6 cases. Eight of these girls are now perfectly continent with a normal social life, including one case with a follow-up of 12 years and a pregnancy. The authors stress the need, in cases of enterocystoplasty, to resect almost all of the pathological detrusor and to use the caecum rather than the hypertonic sigmoid.
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This is a report of a special method of a temporary intravesical electrostimulation of the bladder for the treatment of urinary incontinence of spina bifida children. The technique with presentation of apparatus and catheter is described in details. The criterias for the selection of the patients are explained, the most important of which is the response of the detrusor muscle during the stimulation recorded by uromanometry. 28 spina bifida-children were treated. There is success in 70% of the patients, if the criteria are fulfilled.
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Urodynamic investigations and the measurement of the R-R interval on ECG have been applied to assess the extent of autonomic and peripheral neuropathy in 12 patients with diabetes mellitus. Objective evidence of neuropathic bladder dysfunction was detected in 6 patients (50%) and these cases were included under 2% of the coefficient of R-R interval variation. The commonest abnormality was hypotonic, large bladder and marked residual urine, which was usually asymptomatic. It is concluded that in diabetic patients this simple autonomic function test is a good guide to vesical function.
As no simple test exists to verify objectively a neuromuscular lesion of the detrusor in the clinical practice, pharmacological stimulation of the detrusor with Carbachol was tested. In contrast to other pharmacological tests, the modified Carbachol test never led to false-positive results and is therefore recommended as a basic test in the clinical practice.
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