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PubMedDate not supplied

[Intermittent catheterization as the basis for treatment of neurogenic bladder during childhood].

OBJECTIVE: Neurogenic bladder (NB) frequently causes incomplete bladder emptying, which can lead to deterioration of the upper urinary tract (UUT), vesico-renal reflux (VRR) and incontinence. The aim of this study is to determine the degree of acceptance, performance and results of treatment of NB in children by intermittent catheterization (IC). METHODS: Of 121 children (50 girls and 38 boys) with NB, 88 were managed by intermittent catheterization. The mean age at treatment was 5.2 years (range 20 days-13 years). PVC catheters were employed and reutilized for 3 or 4 weeks. Catheters were aseptic but not sterile. Antimicrobial prophylactic therapy was not administered except in patients with VRR. The statistical study was descriptive and results were compared using the Pearson chi square test. RESULTS: 90% had 4 or more catheterizations daily. Family and patient cooperation was good in 90% of the cases. Patients were managed by IC for a mean period of 4 years (range 1 month-14 years). Only two cases (2%) showed mild, transient complications (urethral pain and cystitis). Normal UUT remained normal in 85%; 45% with compromised UUT improved and 7% became worse. Of the children with no VRR, 94% did not develop this complication; VRR resolved in 72% of the cases (24% by IC alone and 48% with drugs or surgery). Only 12% were continent for more than 3 hours, which increased to 77% (64% by IC alone and 86% with drug therapy or surgery). Urethral sphincter urodynamics was the most important prognostic factor: patients with a lower urethral resistance showed better results for the UUT (p = 0.00373) and VRR (p = 0.00943). The results were also better in patients with normal UUT (p = 0.0003) and no VRR (p = 0.009). CONCLUSIONS: IC is not limited by patient age, sex or sociocultural level. It preserves normal TUS and prevents VRR when instituted early, on demonstrating residual urine and high urethral resistance. IC alone or in combination with other treatments is the basic therapy in NB.

Adolescent↗
PubMed2006

Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder.

BACKGROUND/OBJECTIVE: We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria. METHODS: Eighty-nine persons with bacteriuria were randomized to irrigate their bladders twice daily for 8 weeks with 30 mL of (a) sterile saline, (b) acetic acid, or (c) neomycin-polymyxin solution. Urinalysis, cultures, and antimicrobial susceptibility tests were performed at baseline and weeks 2, 4, and 8 to determine the extent to which each of the solutions affected numbers and types of bacteria, urinary pH, urinary leukocytes, and generation of antimicrobial-resistant organisms. RESULTS: Bladder irrigation was well tolerated with the exception of 3 participants who had bladder spasms. None of the 3 irrigants had a detectable effect on the degree of bacteriuria or pyuria in 52 persons who completed the study protocol. A significant increase in urinary pH occurred in all 3 groups. No significant development of resistance to oral antimicrobials beyond what was observed at baseline was detected. CONCLUSIONS: Bladder irrigation was generally well tolerated for 8 weeks. No advantages were detected for neomycin-polymyxin or acetic acid over saline in terms of reducing the urinary bacterial load and inflammation. We cannot recommend bladder irrigation as a means of treatment for bacteriuria in persons with neurogenic bladder.

Acetic Acid↗
PubMed2004

Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders.

BACKGROUND: Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion. OBJECTIVES: To assess the effects of using different types of urinary catheters and external (sheath) catheters in managing the neurogenic bladder, compared to alternative management strategies or interventions. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised register (searched 11 June 2003). We sought additional trials from other sources such as reference lists of relevant articles and contacting consultants in Spinal Cord Injury Centres throughout the United Kingdom. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing methods of using catheters to manage urinary voiding in people with neurogenic bladder. DATA COLLECTION AND ANALYSIS: Abstracts were independently inspected by the reviewers and full papers were obtained where necessary. MAIN RESULTS: Approximately 400 studies were scrutinised. No trials were found that met the inclusion criteria, and five studies were excluded from the review. REVIEWERS' CONCLUSIONS: Despite a comprehensive search no evidence from randomised or quasi-randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.

Adult↗
PubMedDate not supplied

Diagnostic imaging of neurogenic bladder.

Correct radiologic diagnosis of neurogenic bladder is mainly based on morphofunctional information derived from voiding cystourethrography. This examination allows the evaluation of the bladder morphology, the degree of filling, and the validity of muscular contraction. Indications on the bladder neck, striated sphincter function and urethral morphology are also provided. Presence of ureterovesical reflux is detected with its possible precise classification. Abnormal amount of residual urine is identified and often early diagnosis of most common complications of neurogenic bladder as vesical lithiasis, diverticula and infections, can be established.

Child↗
PubMed1981

[Complications of occult neurogenic bladder disorder in adults].

Occult neurogenic bladder disorder in the case of sacral agenesis is discussed. This disease entity is often overlooked due to the scanty extravesical neurologic findings. A precise urodynamic workup combined with electromyography of the anal sphincter do, however, contribute to diagnosis. Unless occult neurogenic bladder disorder undergoes timely species therapy, it can lead to late damage to the urinary tract.

Adult↗
PubMed1997

The nonneurogenic neurogenic bladder of early infancy.

PURPOSE: The nonneurogenic neurogenic bladder has traditionally been believed to represent a disorder of older children. We report on patients in whom congenital dysfunctional voiding may be the underlying cause of nonneurogenic neurogenic bladder in early infancy. MATERIALS AND METHODS: We evaluated 5 male and 2 female patients newborn to 30 months old with dysfunctional neurogenic bladder and no evidence of neurological pathology or anatomical outflow obstruction. Presentation included prenatal hydronephrosis in 3 cases, urosepsis in 2 and failure to thrive in 2. Radiological and urodynamic investigations revealed thick walled, poorly compliant bladders in 5 patients and incomplete bladder emptying bordering on urinary retention in 2. There was significant upper tract pathology in all cases, including azotemia in 4, reflux in 4 and hydroureteronephrosis in 6. Due to poor bladder function, manifested by incomplete emptying or high storage pressures, all patients were initially treated with cutaneous vesicostomy. RESULTS: Bladder appearance and function subsequently improved in 3 patients and vesicostomy was reversed. Three patients with persistently thickened bladders, including 2 with renal failure, underwent bladder augmentation. The remaining patient had improved bladder storage function but requires intermittent catheterization. CONCLUSIONS: The nonneurogenic neurogenic bladder represents a rare, severe form of dysfunctional voiding that may be present even in the neonatal period.

Child, Preschool↗
PubMed2002

Comparison between conventional cystometry and stimulated filling cystometry by diuretics in a neurogenic bladder after spinal cord injury.

OBJECTIVE: To determine in the neurogenic bladder whether cystometry performed under near physiologic condition by filling stimulation using diuretics reveals different findings compared with conventional cystometry (CMG). DESIGN: One group of subjects from a university teaching hospital was tested in two conditions. The maximum detrusor pressure (MPdet) and compliance of the bladder in CMG and furosemide-stimulated filling cystometry (FCMG) were compared in 27 patients with neurogenic bladder after spinal cord injury. The MPdet was estimated. Compliance was calculated. For CMG, the bladder was filled. FCMG was performed 3 hr after CMG. For FCMG, furosemide was injected after infusion of normal saline. Recording intravesical pressure started after emptying the bladder immediately after furosemide injection. RESULTS: Significant differences were found between CMG and FCMG in hyperreflexic neurogenic bladders with respect to a decrease in MPdet and increase in compliance with FCMG. However, there were no significant differences in MPdet and compliance in hyporeflexic or areflexic neurogenic bladders between the two techniques. CONCLUSION: We have found that FCMG is useful in evaluating both genuine MPdet and compliance in patients with hyperreflexic neurogenic bladder dysfunction. FCMG provides more reliable information on detrusor characteristics than CMG in hyperreflexic neurogenic bladder. We suggest that FCMG is an alternative, effective, and near physiologic diagnostic method, having short assessment time for improving evaluation of the detrusor characteristics of hyperreflexic neurogenic bladder.

Adolescent↗
PubMed1997

The 'Queen Square bladder stimulator': a device for assisting emptying of the neurogenic bladder.

OBJECTIVE: To describe the effectiveness of a vibrating device for emptying the neurogenic bladder in patients with neurological disease. PATIENTS AND METHODS: The study involved 36 patients, comprising 29 with multiple sclerosis (MS), four with multiple system atrophy (MSA), one with radiation myelitis and two with neurological disease of uncertain aetiology. Most patients with MS (27) were able to walk unaided or with aids. Three of the 36 patients had loss of suprapubic sensation (two MS, one with uncertain diagnosis). All patients had free flow rates and ultrasonographic post-void residual volumes (PVRs) measured before and after voiding while using a vibrating device (frequency 60 Hz) applied to the suprapubic region. They also completed questionnaires about their urinary symptoms before and after the continued use of this device. The mean follow-up was 11.5 months (range 8-14). RESULTS: The device improved the symptoms in 25 of 36 patients (70%) and reduced the PVR from a mean (standard deviation) of 175 (78) mL to 68 (32) mL. It was not useful in patients with PVRs of > 400 mL, Kurtzke pyramidal function scores of > 3, and in those with suprapubic numbness. There were no complications and most patients complied well. CONCLUSIONS: Suprapubic vibration is an effective means of emptying the neurogenic bladder in patients who are not severely disabled and who have detrusor hyper-reflexia. It probably acts through a tonic vibration reflex which is under supraspinal influence. This device may be a useful alternative to clean intermittent self-catheterization.

Follow-Up Studies↗
PubMed1994

Bladder autoaugmentation by vesicomyotomy in the pediatric neurogenic bladder.

OBJECTIVES: The authors describe the procedure of bladder autoaugmentation by vesicomyotomy in 12 pediatric patients with neurogenic bladders. METHODS: Indications for augmentation included low-capacity, high-pressure bladders with incontinence despite maximal anticholinergic therapy. Clean intermittent catheterization was successfully reinstituted postoperatively and no patient has subsequently required enterocystoplasty. RESULTS: There were no major complications and eight patients underwent concurrent procedures on the bladder. Urodynamic studies revealed a mean increase in capacity of 40% and a mean decrease in leak point pressure of 33% compared with preoperative values. CONCLUSIONS: Early clinical experience would suggest that vesicomyectomy (excision of released detrusor) offers no advantages over vesicomyotomy in pediatric patients. Vesicomyotomy (simple incision into detrusor) proved to be a simple technique that could be safely performed in pediatric patients.

Adolescent↗
PubMed2000

Bladder-wall abscess in a girl with neurogenic bladder.

We report a case of a bladder-wall abscess in a patient with myelodysplasia and a neurogenic bladder. The aetiology of the abscess was obscure, but the patient had recurrent urinary tract infections and was being managed by clean intermittent catheterisation.

Abscess↗
PubMed1997

Bladder management in patients with pediatric onset neurogenic bladders.

Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p = 0.04), > 10 catheters per month (p = 0.01) and gloves (p < 0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations.

Adolescent↗
PubMed1996

[Decisional criteria in the management of vesico-ureteral reflux in children with congenital neurogenic bladder].

OBJECTIVES: To determine, in the particular case of neurogenic bladder, the best criteria for selection and grading of the modalities available for the treatment of vesicoureteric reflux, which is often associated. METHODS: 194 patients with congenital neurogenic bladder, including 76 cases with vesicoureteric reflux were retrospectively reviewed. The various treatments applied, their results and their complications were reviewed. Conclusions are drawn and proposals are made for the optimal management of vesicoureteric reflux in the particular context of congenital neurogenic bladder. RESULTS: This series included 8 grade I, 28 grade II, 49 grade III and 23 grade IV and V. In more than 50% of cases, reflux was detected on during routine assessment of congenital neurogenic bladder, demonstrating the value of this assessment (25% of cases of reflux were detected before the age of one year). Management initially consisted of vesical drainage, often by intermittent catheterization, from the age of 2 to 3 years and antibiotic prophylaxis. This treatment was sufficient to correct reflux in 9 cases and to control it in 16 cases (no urinary tract infection, no deterioration of the upper tract). An elective anti-reflux operation was decided in 69 cases of VUR (1 grade I, 15 grade II, 38 grade III, 16 grade IV or V). Cohen's technique was performed in 3 cases and endoscopic injection of PTFE was performed in 3 cases. Most of these refluxing bladders were hypertonic and/or presented an abnormally high closing pressure. The operative criteria were: symptomatic reflux; persistent reflux; renal deterioration; non-compliance with treatment. Several complications were observed and are described. CONCLUSION: Vesicoureteric reflux in the context of congenital neurogenic bladder plays a major role in the deterioration of renal function. These forms of reflux usually occur in hypertonic bladders. Urodynamic studies appear essential before deciding treatment. Intermittent catheterization is able to control or even correct a certain number of these cases of reflux and should be introduced by the age of 2 or 3 years. When surgery is required, Cohen's operation is the easiest to perform, but is associated with an increased complication rate. Injection of PTFE or macroplastic could constitute a good indication.

Age Factors↗
PubMed1981

Uninhibited neurogenic bladder treated with Prazosin.

The effect of the new alpha-adrenoreceptor blocking agent prazosin on hypermotility of the urinary bladder was investigated, using controlled cystometry in neurological patients with normal bladder or with uninhibited neurogenic bladder. In short-term administration of prazosin, the bladder capacity was markedly increased and the uninhibited detrusor contraction was diminished. Long-term treatment with prazosin gave subjectively improved micturition in patients with detrusor-sphincter dyssynergia. The cystometrograms then showed less pronounced improvement than in short-term medication. Prazosin offers a valuable supplement to the existing choice off therapeutic agents for uninhibited neurogenic bladder. Side effects of the drug were few.

Adult↗
PubMed1995

[Clean intermittent catheterization in neurogenic bladder patients with vesicoureteral reflux].

BACKGROUND: For neurogenic bladder (NGB) patients with vesicoureteral reflux (VUR), renal deterioration constitutes a primary threat to survival. Although anti-reflux surgery for those patients was reported to be effective, the efficacy of clean intermittent catheterization (CIC) in such patients still remains to be clarified. METHODS: Sixteen neurogenic bladder patients with VUR were treated with CIC. Eight of them had spina bifida and 3 had radical hysterectomy for uterine cancer. Other 5 patients had spinal cord injury, spondyrocace, measles encephalopathy, and 2 unknown diseases, respectively. Hyperactive bladder was noted in 11 patients, whereas hypoactive bladder was noted in 3. Three patients were not evaluated. RESULTS: VUR was improved in only 3 patients (3 ureters), whose VUR grades were not more than III. Nine patients (13 ureters) had to have antireflux surgery. Although 3 of them needed bladder augmentation afterwards, the success rate of the antireflux surgery was 84.6%. CONCLUSION: We concluded that CIC alone was not effective to control VUR in neurogenic bladder patients. Nevertheless, CIC remained a good treatment option when VUR was managed surgically.

Adult↗
PubMed1964

NEUROGENIC BLADDER.

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Abdominal Cavity↗