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PubMedDate not supplied

[Morphological findings on the terminal tract of the ureter in patients with vesico-ureteral reflux associated with neurogenic bladder].

Vesico-ureteral reflux (VUR) associated to neurogenic bladder dysfunctions is well known as pathologic entity; in particular, its radiologic and urodynamic aspects have been widely debated in recent years, even in infancy and childhood. In our study, histologic features of the vesico-ureteral junction have been investigated in a group of patients with neurogenic bladder and VUR, who underwent antireflux surgery. Structural aspects of these vesico-ureteral junctions have been then compared to refluxing junctions taken from non-neurogenic bladders and non-refluxing junctions from normal bladders.

Child↗
PubMed2001

Urinary tract infection in neurogenic bladder.

The most frequent medical complication in patients with neurogenic bladder dysfunction is urinary tract infection (UTI). In the acute phase of neurogenic bladder, aseptic intermittent catheterization should be applied. After this phase, patients are subject to UTIs leading to febrile diseases. In the chronic phase of neurogenic bladders, febrile infections are often accompanied with hypertonic bladder. Some causes or symptoms prior to febrile attack are recognized in many of the cases. Antimicrobial chemotherapy has to be started in time without delay. Newer generation cephalosporins and carbapenems may shorten the febrile period. We report our experience with 229 patients treated between January 1993 and December 1998.

Acute Disease↗
PubMed1981

The management of vesicoureteral reflux in children with neurogenic bladders.

Sixty-two children with 90 refluxing ureters and neurogenic bladder dysfunction were initially managed by clean intermittent catheterisation. The upper urinary systems demonstrated hydronephrosis and/or parenchymal scarring in 57 kidneys and were normal in 33. Each child was placed on low dose antimicrobials and followed nonoperatively unless there was evidence of a febrile urinary tract infection or upper tract deterioration at which point antireflux surgery or urinary diversion was performed. Our experience suggests that children with neurogenic bladders and reflux may be safely managed by clean intermittent catheterisation and that low or moderate degrees of reflux may actually disappear. If recurrent bacilliuria or febrile urinary infections are noted then ureteroneocystostomy is a reliable and effective treatment option in neurogenic bladder disease provided that the bladder dysfunction is controlled. Higher grades of reflux have proven more difficult to manage and in our experience the reflux has not spontaneously abated and frequently there are associated episodes of acute pyelonephritis and renal damage. Because of our success with reimplantation surgery, we now favour early ureteroneocystostomy in such circumstances. With effective management of the neurogenic bladder dysfunction with intermittent catheterisation permanent urinary diversion should only occasionally be necessary because of vesicoureteral reflux.

Adolescent↗
PubMed1999

Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele.

PURPOSE: High pressure dyssynergic voiding may result in irreversible damage to the urinary tract. Prophylactic therapy in the form of clean intermittent catheterization and anticholinergic medication may significantly decrease the incidence of upper urinary tract deterioration. Whether prophylactic therapy in the high risk bladder may also lead to improved long-term bladder dynamics prompted us to study the effect of early versus late treatment of bladder hypertonicity and detrusor-sphincter dyssynergia on the ultimate need for bladder augmentation. MATERIALS AND METHODS: We retrospectively reviewed urological outcomes in patients with myelodysplasia who were at risk for urological deterioration within year 1 of life based on bladder sphincter dyssynergia and/or high filling or voiding pressure. We recorded the dates when high risk voiding dynamics were initially observed, and when intermittent catheterization and anticholinergic therapy were initiated. Patients in whom treatment began at the time a high risk profile was noted (prophylactic group seen between 1985 and 1990) were compared to controls with the same high risk voiding parameters who did not receive early therapy (observation group seen between 1978 and 1984 with therapy instituted 1 year or longer after high risk was noted). The number of augmentations performed in each group was indexed to the total number of years of followup in the 2 populations, respectively. Patients with less than 2 years of followup were excluded from further analysis. RESULTS: Of the 45 patients at risk clean intermittent catheterization and anticholinergic medication were immediately initiated in 18, while 27 were treated expectantly. Patients in the observation group were followed an average of 4.1 years (range 1.1 to 14) before clean intermittent catheterization and anticholinergic medication were started. Of the 27 children treated expectantly 11 (41%) required augmentation, whereas only 3 of the 18 (17%) treated prophylactically required enterocystoplasty. When the number of augmentations was indexed to total years of followup in each of the 2 groups (296 versus 156 years) patients in the expectant group were nearly twice as likely to require augmentation. CONCLUSIONS: Identification and early proactive treatment of the high pressure, dyssynergic lower urinary tract significantly decreases the need for bladder augmentation as children with neurogenic bladder secondary to myelomeningocele mature.

Adolescent↗
PubMed1986

[Neurogenic bladder with pituitary adenoma: report of two cases].

Two cases of neurogenic bladder with pituitary adenoma are reported. The pituitary adenomas produced excessive GH (growth hormone). The etiology of the neurogenic bladder was not identified by X-ray examination or any other tests. Urodynamic study, however, indicated a functional cause of neurogenic bladder. Case 1 was a 55-year-old male, who had a relatively small pituitary adenoma with mild symptoms. Urologically, there was complete urinary retention. Cystometrogram showed a flaccid pattern, detrusor-sphincter dyssynergia in sphincter-EMG and ice water test was negative. Case 2 was a 67-year-old female, who had a large pituitary adenoma and severe symptoms. Cystometrogram showed an almost normal pattern, however, there was detrusor-sphincter dyssynergia and ice water test was negative. We suggested that the neuropeptide takes some part in the pathophysiologic cause of neurogenic bladder.

Adenoma↗
PubMed1986

Experimental neurogenic bladder in rats and effect of Robaveron, a biological prepared from swine prostate, on it.

An experimental neurogenic bladder was induced in rats by an intraspinal injection of 10% phenol-glycerin solution. The functional and biochemical changes in the bladder were studied in vivo and ex vivo, and the effect of Robaveron, a biological prepared from swine prostate, on these changes were examined. The forced voiding pressure in the control rats which had been caused by the neurogenic bladder was reduced to 1/4-1/5 that of the intact animals. Robaveron recovered a decrease in the pressure, and the effect of 150-250 mg/kg, p.o., corresponded nearly to that of 40 mg/kg, i.m. In the ex vivo study with the strips of isolated neurogenic bladder muscle, the time required to cause 50% of the maximum contraction by transmural electric stimulation prolonged to about four times that of the intact one. Such a prolongation was recovered by Robaveron in a dose-dependent fashion, and the effect of Robaveron given p.o. corresponded to about 1/6 that of the drug given i.m. No change in Ca2+-influx, was found, although Ca2+-efflux was inhibited in the strip of neurogenic bladder muscle. Such an inhibition was significantly relieved in that of animals treated with Robaveron. In the neurogenic bladder rat, the ratio of bladder weight to body weight increased, and the activities of total ChE and AChE in the bladder muscle decreased, on which Robaveron did not show any influence. Phasic and tonic contractions in the strips of intact rat bladder and guinea pig ileum were inhibited by La3+, particularly phasic response in both the strips. Robaveron recovered the inhibition in a dose-dependent fashion. The present study suggests that the urinary dysfunction in neurogenic bladder may be caused not only by nervous disorders but also by changes in the bladder muscle itself. Robaveron was found to be effective for most of such changes. These findings may support the clinical efficacy of Robaveron for improving the attenuated bladder function.

Animals↗
PubMed1987

Incontinence in female neurogenic bladders. Resolution by endoscopic bladder neck suspension.

Five incontinent females with neurogenic bladder diseases underwent endoscopic vesical neck suspension (Stamey procedure). Four patients have become dry on clean intermittent catheterisation and one has shown improvement. Bladder capacity was increased to a reasonable size in all patients. There has been no upper tract deterioration during the follow-up period of 3 to 25 months. We believe that the Stamey procedure is useful in alleviating urinary incontinence in neurogenic bladders provided that the bladder is drained regularly by intermittent catheterisation and that low detrusor compliance or detrusor hyper-reflexia is adequately managed.

Adolescent↗
PubMed1976

Silicone-gel prosthesis in treatment of urinary incontinence secondary to neurogenic bladder dysfunction.

Patients with lower neuron lesion neurogenic bladder, with normal upper urinary tracts, poor closing pressure of the urethra, and absence of vesicoureteral reflux can be considered candidates for the insertion of the silicone-gel (Kaufman) prosthesis. Our results in 10 cases indicated that there is a place for passive urethral compression in the treatment of neurogenic bladder after a careful selection of patients and using objective methods to regulate the amount of urethral compression. The use of a combined operation (silicone-gel prosthesis and a Small-Carrion prosthesis) in some of the cases is also presented.

Adult↗
PubMed1996

Possible use of ultrasonically-estimated bladder weight in patients with neurogenic bladder dysfunction.

In 25 patients with detrusor areflexia, ultrasonically-estimated bladder weight (UEBW) was compared with bladder capacity and compliance obtained by cystometry, and UEBW was also compared with grade of bladder deformity as evaluated by cystography. UEBW correlated significantly with compliance (P < 0.01) and degree of bladder deformity (P < 0.01). Taking a cutoff value of 40 g, UEBW revealed diagnostic accuracy as high as 96% and 80% for low-compliance (< 10 ml/cm H2O) and high-grade deformity (grade II/III), respectively. UEBW could be a new urodynamic parameter capable of evaluating functional as well as morphological changes of the bladder.

Adult↗