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Various types of neurogenic bladder dysfunction in children show characteristic changes on micturating cystograms. The reflex bladder shows a short area of narrowing of the urethra at the pelvic floor; the autonomous bladder, during voiding by straining or Credé shows an elongated and deformed urethra, which is narrowed at the pelvic floor and which, because of the low position of the bladder, is angled. Both spastic and paretic pelvic floor in association with neurogenically determined abnormalities of bladder emptying may result in functional obstruction of the urethra. This, like any other stenosis, leads to morphological changes, first in the lower, but subsequently in the upper urinary tract. Children with neurogenic bladder dysfunction occasionally have micturating cystograms which resemble the appearances of urethral valves. The occurrence of so-called occult neurogenic bladders is mentioned and the difficulties in diagnosis associated with this condition are stressed.
BACKGROUND: The complexity of neurogenic bladder (NGB) management underscores the importance of caregiver education, yet high-quality education materials remain scarce. This study aims to assess the effectiveness and acceptability of an educational video designed to improve knowledge about NGB among caregivers of children with this condition. METHODS: We identified English-speaking caregivers of patients aged zero to 18 years, diagnosed with NGB, without prior major bladder reconstructive surgery, who received care at our institution from 2018 to 2022. Caregivers were randomly assigned into control or video groups using a block randomization model based on age. The control arm completed a six-item knowledge assessment before viewing the video, while the video group watched the video first. All participants rated the video's acceptability. Qualitative analysis of the open-ended responses to the acceptability questionnaire followed principles of thematic analysis. RESULTS: Of 409 eligible participants, 106 (25.9%) completed the study. Video (n = 48) and control (n = 58) groups were demographically similar. In the video group, 64.6% answered correctly all questions in the knowledge questionnaire, compared to 31% in the control group. After adjusting for patient age, caregivers in the video group were more likely to answer any question in the knowledge assessment correctly (relative probability: 1.13, 95% CI [1.06, 1.21], p < 0.01). Evidence for a difference in correct response rate among individual questions was strongest for question #1, which asked about common urological conditions for which NGB patients are at higher risk (95.8% vs. 79.3%, p = 0.01), and question #6, which asked about indications for bladder surgery (87.5% vs. 67.2%, p = 0.01), with the video group more likely to answer correctly for both questions. Qualitative analysis identified three major themes regarding parents' acceptance of the educational video: 1) attitudes towards video content and presentation, 2) usefulness of video as an educational tool, and 3) future directions. CONCLUSIONS: Our study found that an educational video about NGB effectively enhanced parental understanding of the condition and was deemed acceptable by parents as an introductory educational tool. The literature shows the benefit of using technology and visual aids to enhance health literacy for patients and caregivers, a key first step towards optimizing health outcomes for pediatric urologic patients.
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Today neuropharmacas are a helpful part in the conservative treatment of the neurogenic bladder disorders. They are, or course, no "wonder-drugs" and usually lead to an improvement only of the troubles, but rarely to complete cure. If monotherapy does not lead to the results wanted, one should combine drugs of the same of similar effects but with different pharmacologic targets. A real progress was reached through alpha-receptor-blockers, whose use has, especially in children with myelomeningocele, changed the therapeutic concept in favour of a largely conservative treatment. We already know a number of substances that in one way or other influence the muscles of the bladder and the bladder outlet. If only part of them will reach clinical usage, it can be assumed that the pharmacotherapy will become even more meaningful in the treatment of neurogenic bladder disorders.
The response of the urethra in patients with chronic neurogenic bladders to autonomic stimulation was investigated by urethral pressure profile. A consistent supersensitivity to alpha-adrenergic stimulation was documented. Experiments with various autonomic blocking drugs confirmed that this response is alpha-adrenergically mediated via the short neuron system. The results appear to offer pharmacological evidence for the recently evolving intricate innervation pattern of the urethra including its distal portion, where the alpha-adrenergic system is believed to be important.
A carefully controlled programme of intermittent catheterization provides substantially better care of the bladder than indwelling catheters during the initial period after acute spinal cord injury. It is very difficult to maintain a programme of intermittent catheterization around the clock without a small team of nursing personnel highly skilled in the technique of aseptic catheterization. the practical details of setting up a catheter team are described. Some of the results that have been associated with the establishment of such a team at the Rehabilitation Branch of the Royal Perth Hospital are presented.
The effect of the simultaneous administration of hexamine mandelate and methionine on the urinary excretion of calcium, magnesium and phosphate is reported in 3 groups of paraplegic patients. Long-term therapy with G 500 increases bone loss in paralysed patients, and is contra-indicated when there is infection of the urinary tract by urea-splitting organisms.
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We examined 18 patients with lesion of the lower motor neuron, conditioned partly by lesion of the spinal cord, partly by lesion of the peripheral vesical nerves, before and after the percutaneous electrostimulation (myelotron) and established the urodynamically verified effect. Apart from one case of unclarified and fully therapy-resistent atony of the urinary bladder we found in all patients a subjective improvement of their complaints (retarded beginning of miction, spontaneous miction only with straining, large quantities of residual urine). Objectively an improvement of the sensitivity of the urinary bladder or of the motoricity appeared, in most cases both. We could not establish an essential influence on the tonus of an empty bladder and the tonus of the sphincter musculature. In all patients the residual urine could be reduced drastically, after the treatment the major part of the patient could urinate without residual urine.
The authors present long term results (19 to 45 months: Average 37 months) of electrical stimulation of the conus medullaris in neurologic bladder. In 3 cases, the result remain excellent: efficient stimulation, normal micturition, absence of residual urine. In 6 cases, after a long period of normal function, the micturition is poor with residual urine, eventhough the conus medullaris stimulation always produces a satisfactory contraction of the detrusor. In four cases the relapse is due to disease of the external sphincter region, poorly or untreated. In female patients the results are better than in male patients, with positive results in 2 of the 3 women and 1 of the 6 men. The authors find that their results can be compared with those of B. NASCHOLD, originator of the method. They emphasize the necessity of a close collaboration with the urologist to maintain excellent results.
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