1
|
da Silva CMP, de Almeida Vasconcelos MM, Lima EM, de Bessa J, Reis OAF, Filgueiras MFTF, de Azevedo RVM, Bastos JM, Oliveira EA, de Carvalho Mrad FC. Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder. Int Braz J Urol 2023; 49:700-715. [PMID: 37624657 PMCID: PMC10947619 DOI: 10.1590/s1677-5538.ibju.2023.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/22/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). MATERIALS AND METHODS A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. RESULTS A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. CONCLUSION DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.
Collapse
Affiliation(s)
- Carlos Magno Paiva da Silva
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - Mônica Maria de Almeida Vasconcelos
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - Eleonora Moreira Lima
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de UrologiaFeira de SantanaBABrasilDepartamento de Urologia, Universidade Estadual de Feira de Santana – UEFS, Feira de Santana, BA, Brasil
| | - Otávio Augusto Fonseca Reis
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - Maria Francisca Tereza Freire Filgueiras
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - Roberta Vasconcellos Menezes de Azevedo
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - José Murillo Bastos
- Universidade Federal de Juiz de ForaDepartamento de UrologiaFaculdade de MedicinaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Medicina, Universidade Federal de Juiz de Fora – UFJF, Juiz de Fora, MG, Brasil
- Faculdade de Ciências Médicas de Juiz de Fora e Maternidade Therezinha de JesusDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas de Juiz de Fora e Maternidade Therezinha de Jesus, Juiz de Fora, MG, Brasil
| | - Eduardo Araújo Oliveira
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| | - Flávia Cristina de Carvalho Mrad
- Faculdade de Medicina Universidade Federal de Minas GeraisDepartamento de Pediatria e Unidade de Nefrologia PediátricaBelo HorizonteMGBrasilDepartamento de Pediatria e Unidade de Nefrologia Pediátrica, Faculdade de Medicina Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brasil
| |
Collapse
|
2
|
Chawla A, Patil MC, Reddy SJ, Pillai S, N SSB. Global Differences in Management of Neurogenic Bladder: Indian Perspective. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
3
|
Continence management in children with severe caudal regression syndrome: role of multidisciplinary team and long-term follow-up. Pediatr Surg Int 2022; 38:1461-1472. [PMID: 35943565 DOI: 10.1007/s00383-022-05168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Caudal regression syndrome (CRS) is a rare congenital abnormality including orthopedic deformities, urological, anorectal, and cardiac malformations. The clinical spectrum of CRS varies in severity, therefore multiple surgeries and complex medical care may be required with the efforts and support of a multidisciplinary team to ensure the most accurate treatment and the best outcome. The aim of our retrospective study was to evaluate the role of a multidisciplinary treatment and the long-term outcome in patients with severe CRS. METHODS Clinical, surgical and psychological data were collected for all patients with diagnosis of CRS, treated at our Pediatric Hospital from January 1995 to December 2020. Patients with a severe form of CRS according to Pang's classification were included in the study. All patients have been followed by a multidisciplinary team composed by urologists, neurosurgeons, neonatal and digestive surgeons, orthopedic surgeon, physiatrists and psychologists. On admission, patients were screened for CRS with sacrum, spine and legs X-ray, spine MRI, renal ultrasound, voiding cystography and urodynamic, and renography. Clinical data about bowel function were evaluated. RESULTS During the study period, 55 patients with CRS were treated at our Institution. Six out of 55 (10.9%), presented with severe form of CRS (5 pts with type 1; 1 pt, with type 2) and represent our study group. Diagnosis of severe CRS was made at birth because of the typical deformities of the pelvis (fusion of the iliac wings), and of the lower extremities (undeveloped legs with flexion of the knees, clubfoot). All patients presented with neurogenic bladder, 4/6 (66.6%) with vesicoureteral reflux (VUR) and 2/6 (33.3%) with renal agenesia and contralateral ectopic hypoplastic kidney. Bowel symptoms occurred in 5/6 pts (83.3%). All patients were started with an earlier clean intermittent catheterization (CIC) regimen. In 3 patients oxybutynin has been effective or well tolerated, while in other 3 onabotulinumtoxin A has been used. Vesicoureteral reimplantation has been performed in 1 patient, 2 required endoscopic treatment of VUR. On long-term, 2 patients required bladder augmentation with ileum and appendicostomy (Mitrofanoff). Low adherences in CIC have been observed in three patients, mainly at puberty. Two patients presented with chronic renal failure. One patient reported suicide proposal. Regarding social life, only one is regularly performing sport activity. CONCLUSION CRS is characterized by maldevelopment of the caudal half of the body with variable involvement of the gastrointestinal, genitourinary, skeletal, and nervous systems. Management of CRS includes a wide variety of interventions to address the full spectrum of possible anatomical abnormalities. Hence, a multidisciplinary team is also mandatory for a correct bladder and bowel management, in order to maintain continence and preserve renal function, improve quality of life and increase self-esteem.
Collapse
|
4
|
Li L, Tang L, Bi Y. Intrauterine neuromuscular and stromal dysplasia of the bladder in retinoic acid-induced myelomeningocele fetal rats. Tissue Cell 2022; 78:101872. [DOI: 10.1016/j.tice.2022.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
|
5
|
Alomar MA, Alghafees MA, Aljurayyad A, Alsuhaibani HS, Almaiman SS, Alotaibi TS. Neurogenic Bladder-Induced Stone in a Pelvic Kidney of a Caudal Regression Syndrome Patient: Management of a Complex Case. Cureus 2022; 14:e25479. [PMID: 35783872 PMCID: PMC9241482 DOI: 10.7759/cureus.25479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/05/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is a difficult treatment for treating kidney stones, especially when there are orthopedic or skeletal abnormalities. Here, in a 19-year-old male, we describe a two-step PCNL with a case of caudal regression syndrome (CRS) and a pelvic kidney, with an extremely deformed neurogenic bladder on intermittent catheterization. Our conclusion is that PCNL may be done safely with minimum morbidity in patients with caudal regression syndrome by utilizing adult equipment for heavy stone burdens, allowing full and rapid stone removal.
Collapse
|
6
|
Sager C, Barroso U, Bastos JM, Retamal G, Ormaechea E. Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment. Int Braz J Urol 2021; 48:31-51. [PMID: 33861059 PMCID: PMC8691255 DOI: 10.1590/s1677-5538.ibju.2020.0989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. MATERIALS AND METHODS Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifida, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. RESULTS AND DISCUSSION The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.
Collapse
Affiliation(s)
- Cristian Sager
- Service of Urology, National Hospital of Pediatrics Prof. Dr. P. J. Garrahan, Buenos Aires, Argentina
| | - Ubirajara Barroso
- Departamento de Urologia, Universidade Federal da Bahia - UFBA, Salvador, BA, Brasil.,Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil
| | - José Murillo Bastos
- Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil.,Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil
| | | | | |
Collapse
|
7
|
Hage D, Iwanaga J, Dumont AS, Tubbs RS. Caudal regression syndrome and a pelvic kidney: case report. Anat Cell Biol 2020; 53:509-511. [PMID: 32647073 PMCID: PMC7769103 DOI: 10.5115/acb.20.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital variation. A high incidence of renal and genitourinary malformations has been observed in patients with CRS, with the most common being neurogenic bladder and renal agenesis. We report a rare case report documenting both CRS and a pelvic kidney found during a diagnostic magnetic resonance imaging. Although renal anatomy variants are found in patients with CRS, a pelvic kidney is normally not part of the constellation of findings in this malformation. As seen in our patient, a pelvic kidney should be considered in patients suspected of having CRS.
Collapse
Affiliation(s)
- Dany Hage
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| |
Collapse
|
8
|
Tessi C, Burek CM, Sager C, Szklarz MT, Vásquez M, López Imizcoz F, Ruiz J, Weller S, Gomez Y, Corbetta JP. Bladder Volume Assessment in Pediatric Patients With Neurogenic Bladder: Is Ultrasound an Accurate Method? Urology 2020; 147:250-255. [PMID: 33053401 DOI: 10.1016/j.urology.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To define the accuracy of ultrasound to determine bladder volume in pediatric patients with neurogenic bladder (NB). METHODS Retrospective analysis of children with NB in treatment with urethral clean intermittent catheterization. EXCLUSION CRITERIA bladder surgeries, and catheterization through a channel different than urethra. Bladder volume was measured with ultrasound using the formula: anteroposterior bladder diameter by side to side diameter by distance from dome to outlet tract by 0.523 (cm3). In the same act, the patient was performed urethral catheterization and the drained volume was measured in millimeters. Finally, postvoid residual volume (PVR) was assessed with ultrasound. RESULTS We performed 318 measurements in 299 patients, mean age was 9.95 years (standard deviation: 4.6), 59% were female. Most frequent etiologies of NB were myelomeningocele and lipomyelomeningocele. Mean ultrasound-determined bladder volume was 213.9cm3 (range: 20-899 cm3) and mean bladder volume drain through catheterization was 336.4 mL (range: 30-1480 mL; P : .0001). In 67.3% of the patients (n: 214) PVR was not significant, and their mean ultrasound volume was 212.7 mL and the volume evacuated by catheterization was 339.9 mL (P : .0001). In all age groups ultrasound-determined bladder volume was statistically lower than catheterized bladder volume (P : .0001). The mean percentage error of the ultrasound-determined bladder volume was 15.58% ± 44.09. Linear regression analysis and Bland-Altman plot showed low agreement between both measurement techniques. CONCLUSION In children with NB, ultrasound-determined bladder volume was statistically lower than catheterized bladder volume measured at the same moment, and this relation persisted regardless of sex, age, and the presence of PVR.
Collapse
Affiliation(s)
- Catalina Tessi
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
| | - Carol M Burek
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Cristian Sager
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María T Szklarz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Mariana Vásquez
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Felicitas López Imizcoz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Javier Ruiz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Santiago Weller
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Yesica Gomez
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| |
Collapse
|
9
|
Wide P, Duchén K, Mattsson S, Glad Mattsson G. Four-hour voiding observation with provocation test reveals significant abnormalities of bladder function in newborns with spinal dysraphism. J Pediatr Urol 2020; 16:491.e1-491.e7. [PMID: 32782223 DOI: 10.1016/j.jpurol.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Four-hour voiding observation with provocation test (VOP) using a scale, a damp detector and ultrasound for determination of residuals, is an easily performed non-invasive method for the evaluation of bladder function in newborns. Neonatal bladder function evaluated with VOP has been described for healthy newborns (HN) but not for children with spinal dysraphism (SD), for whom early bladder evaluation is essential for decisions regarding Clean Intermittent Catheterization and follow-up. The aim of the present study was to describe voiding observation with provocation test in newborns with spinal dysraphism and compare with corresponding data for healthy newborns. METHODS AND MATERIALS At a tertiary hospital, a 4 h voiding observation with provocation (VOP) was performed in 50 neonates (22 girls, 28 boys) with spinal dysraphism (37 open SD, 13 closed SD) consecutively evaluated for possible neurogenic bladder-sphincter dysfunction (1998-2019). All newborns with open SD and 4/13 with closed SD had been through postnatal neurosurgery before the test. Mean age was 10 days. Voiding observation was performed during 4 h with visual observation the fourth hour recording behavior and urinary flow (e.g. stream, dribbling). Finally, bladder provocations (e.g. suprapubic compression) were performed, and any leakage was noted. Findings were compared to those of 50 healthy newborns (HN) earlier published (Gladh et al., 2002). There were no significant differences in background data such as gender, age or diuresis between newborns with SD and HN. RESULTS AND DISCUSSION Voiding observation with provocation test of children with SD revealed significant differences compared to HN see summary table. Some children with SD had frequent small voids/leakages and low bladder volumes while three had no voiding and high volumes. Leakage during bladder provocation test and not voiding with a stream was not seen in HN but were common in newborns with SD (69% resp. 74%) (p < 0.01). A child with these findings should thus be investigated further. Identifying children needing Clean Intermittent Catheterization is important as well as being able to postpone or refrain from invasive urodynamic studies if not strongly indicated. VOP may give valuable information for these judgements. CONCLUSION Newborns with spinal dysraphism differ from healthy newborns in many aspects of bladder function. Bladder function varies between newborns with closed and open spinal dysraphism. Many newborns with spinal dysraphism leak at bladder provocation and void without a stream but healthy newborns do not. Early determination of post-void residuals is mandatory in children with spinal dysraphism and non-invasive VOP gives this information in a standardized way, also adding information on frequency, voiding with a stream and leakage at provocation.
Collapse
Affiliation(s)
- Peter Wide
- Department of Biomedical and Clinical Sciences and Department of Pediatrics, Linköping University, SE-581 83, Linköping, Sweden.
| | - Karel Duchén
- Department of Biomedical and Clinical Sciences and Department of Pediatrics, Linköping University, SE-581 83, Linköping, Sweden.
| | - Sven Mattsson
- Department of Biomedical and Clinical Sciences and Department of Pediatrics, Linköping University, SE-581 83, Linköping, Sweden.
| | - Gunilla Glad Mattsson
- Department of Biomedical and Clinical Sciences and Department of Pediatrics, Linköping University, SE-581 83, Linköping, Sweden.
| |
Collapse
|
10
|
Warner T, Scullen TA, Iwanaga J, Loukas M, Bui CJ, Dumont AS, Tubbs RS. Caudal Regression Syndrome-A Review Focusing on Genetic Associations. World Neurosurg 2020; 138:461-467. [PMID: 32200015 DOI: 10.1016/j.wneu.2020.03.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/31/2022]
Abstract
Caudal regression syndrome (CRS) represents a spectrum of clinical phenotypes with varying degrees of malformation of the lower body with involvement of structures deriving from all 3 layers of the trilaminar embryo. We review areas of active investigation in the diagnosis, etiology, epidemiology, and treatment of the disease with a focus on underlying genetics. CRS pathobiology is complex and multifactorial with a significant contribution from environmental factors as evidenced in twin studies. Contemporary genomic and genetic investigations in both human primary tissue and murine in vitro and in vivo models implicate various genes associated with caudal differentiation and neural cell migration in embryogenesis. A large number of identified targets center around the metabolic regulation of retinoic acid and its derivatives. Dysregulation of retinoic acid homeostasis has been associated with abnormal embryonic cell migration, differentiation, and organogenesis with resulting malformations and agenesis in both a laboratory and a clinical setting. There appears to be a significant overlap in potential genetic targets with CRS and other developmental syndromes with similar presentations, such as VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. CRS represents a spectrum of caudal developmental abnormalities with treatment options limited to mild and moderate expressions of disease. Continued research is necessary to further clarify mechanisms of disease pathobiology and complex polygenetic and environmental interaction. Despite this, progress has been made in identifying genetic targets and downstream effectors contributing to preclinical and clinical progression.
Collapse
Affiliation(s)
- Tyler Warner
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Tyler A Scullen
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - C J Bui
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
11
|
Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quadackers JSLT, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment. Neurourol Urodyn 2019; 39:45-57. [PMID: 31724222 DOI: 10.1002/nau.24211] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.
Collapse
Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, 1st Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine S L T Quadackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
12
|
Vilanova-Sanchez A, Reck CA, Sebastião YV, Fuchs M, Halleran DR, Weaver L, Gregory Bates D, Gasior AC, Maloof T, Hoover EJ, Jaggers J, Gagnon R, Ching CC, Dajusta D, Jayanthi VR, Levitt MA, Wood RJ. Can sacral development as a marker for caudal regression help identify associated urologic anomalies in patients with anorectal malformation? J Pediatr Surg 2018; 53:2178-2182. [PMID: 29680275 DOI: 10.1016/j.jpedsurg.2018.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM The sacral ratio (SR) is a well-established tool to quantify sacral development in patients with anorectal malformations (ARM) and can be used as a predictor of fecal continence. We hypothesized that a lower SR correlated with the presence of urologic and renal malformations. METHODS We retrospectively reviewed the medical records of patients with ARM treated at our center from 2014 to 2016. We measured the lateral SR as a marker for sacral development and assessed the spine for the presence of tethered cord (TC). Urological and renal anomalies, including single kidney, hydronephrosis, hypospadias, vesicoureteral reflux (VUR), ectopic ureter, and penoscrotal transposition were assessed. Analysis of variance (ANOVA), t-tests, and multivariable linear regression were used to test for differences in SR with consideration of associated urologic malformations and tethered cord. RESULTS 283 patients with ARM were included for analysis (156 females). The median age was 39months (10-90). Among these, 178 (55.6%) had 1 or more urologic malformations, and 81 (25.3%) had a TC. Hydronephrosis, high-grade VUR (3-5), solitary kidney, and tethered cord were significantly associated with lower SR (p<0.01). In multivariable regression models, the presence of urologic abnormalities remained significantly associated with lower a SR despite the presence or absence of TC (p<0.001). CONCLUSION SR is a potentially useful indicator of certain urologic anomalies including hydronephrosis, high grade VUR, and solitary kidney in patients with ARM. This association is independent of the presence of TC. A sacral ratio as a part of the VACTERL screening can help the surgeon identify which patients need closer urologic follow up. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH
| | - Molly Fuchs
- Pediatric Urology Department, Nationwide Children's Hospital, Columbus, OH
| | - Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - D Gregory Bates
- Children's Radiological Institute, The Ohio State College of Medicine and Public Health, Columbus, OH
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Erin J Hoover
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Jordan Jaggers
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Renae Gagnon
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Christina C Ching
- Pediatric Urology Department, Nationwide Children's Hospital, Columbus, OH
| | - Daniel Dajusta
- Pediatric Urology Department, Nationwide Children's Hospital, Columbus, OH
| | - Venkata R Jayanthi
- Pediatric Urology Department, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
13
|
Bray JJH, Crosswell S, Brown R. Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis. BMJ Case Rep 2017; 2017:bcr-2017-219786. [PMID: 28476907 DOI: 10.1136/bcr-2017-219786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sacral agenesis is a rare congenital defect which is associated with foot deformities such as congenital talipes equinovarus (CTEV) and less commonly congenital vertical talus (CVT). We report a 3-year-old Caucasian girl who was born with right CTEV and left CVT secondary to sacral agenesis. Her right foot was managed with a Ponseti casting method at 2 weeks, followed by an Achilles tenotomy at 4 months. The left foot was initially managed with a nocturnal dorsi-flexion splint. Both feet remained resistant and received open foot surgery at 10 months producing plantigrade feet with neutral hindfeet. At 19 months, she failed to achieve developmental milestones and examinations revealed abnormal lower limb reflexes. A full body MRI was performed which identified the sacral agenesis. We advocate early MRI of the spine to screen for spinal defects when presented with resistant foot deformities, especially when bilateral.
Collapse
Affiliation(s)
- Jonathan James Hyett Bray
- Trauma and Orthopaedic Department, Cheltenham General Hospital, Cheltenham, UK.,Bristol Royal Infirmary, University of Bristol Academy, Bristol, UK
| | - Sebastien Crosswell
- Department of General Surgery, The Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Rick Brown
- Trauma and Orthopaedic Department, Cheltenham General Hospital, Cheltenham, UK
| |
Collapse
|
14
|
Targeting of the Plzf Gene in the Rat by Transcription Activator-Like Effector Nuclease Results in Caudal Regression Syndrome in Spontaneously Hypertensive Rats. PLoS One 2016; 11:e0164206. [PMID: 27727328 PMCID: PMC5058558 DOI: 10.1371/journal.pone.0164206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/21/2016] [Indexed: 12/01/2022] Open
Abstract
Recently, it has been found that spontaneous mutation Lx (polydactyly-luxate syndrome) in the rat is determined by deletion of a conserved intronic sequence of the Plzf (Promyelocytic leukemia zinc finger protein) gene. In addition, Plzf is a prominent candidate gene for quantitative trait loci (QTLs) associated with cardiac hypertrophy and fibrosis in the spontaneously hypertensive rat (SHR). In the current study, we tested the effects of Plzf gene targeting in the SHR using TALENs (transcription activator-like effector nucleases). SHR ova were microinjected with constructs pTAL438/439 coding for a sequence-specific endonuclease that binds to target sequence in the first coding exon of the Plzf gene. Out of 43 animals born after microinjection, we detected a single male founder. Sequence analysis revealed a deletion of G that resulted in frame shift mutation starting in codon 31 and causing a premature stop codon at position of amino acid 58. The Plzftm1Ipcv allele is semi-lethal since approximately 95% of newborn homozygous animals died perinatally. All homozygous animals exhibited manifestations of a caudal regression syndrome including tail anomalies and serious size reduction and deformities of long bones, and oligo- or polydactyly on the hindlimbs. The heterozygous animals only exhibited the tail anomalies. Impaired development of the urinary tract was also revealed: one homozygous and one heterozygous rat exhibited a vesico-ureteric reflux with enormous dilatation of ureters and renal pelvis. In the homozygote, this was combined with a hypoplastic kidney. These results provide evidence for the important role of Plzf gene during development of the caudal part of a body—column vertebrae, hindlimbs and urinary system in the rat.
Collapse
|
15
|
Bauer SB, Austin PF, Rawashdeh YF, de Jong TP, Franco I, Siggard C, Jorgensen TM. International Children's Continence Society's recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 2012; 31:610-4. [PMID: 22532312 DOI: 10.1002/nau.22247] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/05/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The objective of this ICCS standardization document is to report the initial diagnostic evaluation and subsequent work-up of children with neuropathic bladder dysfunction. MATERIALS AND METHODS Due to a paucity of level I or level II, "levels of evidence" publications, these recommendations are actually a compilation of best practices because they seem to be effective and reliable, although not with any control. RESULTS Throughout the document, the emphasis is on promoting early, comprehensive evaluation of lower urinary tract function that is thorough but with a minimum of unnecessary testing. This includes what tests to order, when to order them and what to do with the results. Some of the recommendations may not be practical in various worldwide locations but the suggested testing should be considered the ideal approach to completely diagnosing and then promulgating treatments based on the full knowledge of the condition and its effect on urinary tract function. Once the findings are delineated, those lower urinary tract patterns of dysfunction that put the kidneys at risk for deterioration, that are barriers to attaining eventual continence, and that have long-term consequence to the lower urinary track can be obviated by specific management recommendations. The indications and timing of investigations to achieve these objectives are clearly defined in each diagnostic category and during follow-up. RECOMMENDATIONS This document should be used as a basis for appropriate evaluation and timely surveillance of the various neuro-urologic conditions that affect children.
Collapse
|
16
|
Emami-Naeini P, Nejat F, Rahbar Z, Kajbafzadeh A, El Khashab M. Urological manifestations of sacral agenesis. J Pediatr Urol 2012; 8:181-6. [PMID: 21398186 DOI: 10.1016/j.jpurol.2011.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 02/08/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate urologic manifestations of sacral agenesis (SA) and their association with bony defects. METHODS Urological manifestations of SA were investigated in 50 patients referred to the urology or neurosurgery department. Urologenital signs and symptoms were assessed and a complete history of previous surgical procedures was attained. Plain lumbosacral radiography, abdominal/pelvic ultrasound, voiding cystourethrogram and urodynamic study were evaluated if available. RESULTS The most common urologic complaints were urinary incontinence and/or constant dribbling, seen in 30 (85%) of 35 children aged 4 years and over. Recurrent urinary tract infection, the second most common, was seen in 37 (74%). Vesicoureteral reflux was identified in 32 (65.3%) patients, 19 (59.3%) were found to have high maximal voiding pressures and post-voiding residual urine was notable in 42 (85.7%). Abnormal urodynamic parameters were found to be consistent with a neurogenic bladder in all patients. Cases were divided into upper motor lesions (in 34) and lower motor disorders (in 15). There was no statistically significant correlation for any GU finding with type of bony aplasia or motor neuron lesion (P = 0.338). CONCLUSION Voiding impairment and VUR together with recurrent UTI, especially in children with associated renal anomalies, contribute to renal damage. Urinary incontinence with associated social problems frequently occurs in patients with SA. Considering the devastating consequences of this disease in the urinary tract, timely diagnosis, thorough evaluation and appropriate intervention are essential.
Collapse
Affiliation(s)
- Parisa Emami-Naeini
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
17
|
Cox A, Breau L, Connor L, McNeely PD, Anderson PA, MacLellan DL. Transition of care to an adult spina bifida clinic: patient perspectives and medical outcomes. J Urol 2011; 186:1590-4. [PMID: 21855907 DOI: 10.1016/j.juro.2011.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE Transitioning care of patients with spina bifida to adult centers poses a challenge. We sought patient and parent perspectives on the transition process at our center and correlated these perspectives with medical outcomes. MATERIALS AND METHODS Patients who attended the adult spina bifida clinic at our institution were invited to complete SF-36®, the Ambulatory Care Experience Survey and a Transition of Care Survey. Urological and neurosurgical medical outcomes were correlated with health status, clinic experience and perspectives on the transition process. Statistical analysis was done using SPSS®, version 16.0. RESULTS Of 105 patients with spina bifida 24 participated in the study. SF-36 results showed that the physical health domain correlated with lack of employment (p = 0.006). Patients whose parents completed the surveys on their behalf were more likely to have physical limitations than the patients who completed surveys (p = 0.011). Urological and neurosurgical outcomes did not significantly affect SF-36, Ambulatory Care Experience Survey or Transition of Care Survey scores in this patient population. Patients and caregivers identified similar key elements and barriers in the transition process. Satisfaction with care at the pediatric center was higher than at the adult center. CONCLUSIONS Transitioning care of patients with spina bifida from pediatric to adult care poses challenges for the health care system. Medical outcomes do not impact the patient perspective of the transition process. To optimize the transition of care we must address the barriers identified by patients and their caregivers.
Collapse
Affiliation(s)
- Ashley Cox
- Department of Urology, QEII Health Science Centre, Halifax, Nova Scotia, Canada
| | | | | | | | | | | |
Collapse
|
18
|
Torre M, Guida E, Bisio G, Scarsi P, Piatelli G, Cama A, Buffa P. Risk factors for renal function impairment in a series of 502 patients born with spinal dysraphisms. J Pediatr Urol 2011; 7:39-43. [PMID: 20363192 DOI: 10.1016/j.jpurol.2010.02.210] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the risk of renal damage in a large series of patients affected by spinal dysraphism. METHODS Renal function was studied in 502 spinal dysraphisms treated over the last 25 years in a single center: 283 meningomyelocele (MMC), 90 caudal regression syndrome (CRS) and 129 spinal lipoma (SL) cases. In patients with normal and impaired renal function, we compared congenital renal anomalies, vesicoureteric reflux, bladder voiding pattern and upper tract dilatation, analyzing the results with the Fisher test. RESULTS Neuropathic bladder was observed in 97% of MMC, 60% of CRS, and 39% of SL cases. There was some degree of renal function impairment in 19 MMC (6.7%), 11 CRS (12%, increased to 20% if considering only neuropathic bladder patients), and two SL (1.5%) cases. Renal agenesis was more frequent in CRS (13%), but was not associated with decreased renal function. Overall, vesicoureteric reflux and upper tract dilatation were more frequent in patients with renal damage. Insufficient bladder voiding was statistically associated with renal damage only in the CRS population. Intermittent catheterization did not represent a protective factor against renal damage in patients able to void without significant residual urine. CONCLUSION This study has increased our understanding of the prognostic risk factors for renal deterioration. More prospective studies are necessary to confirm these results and correlate treatment with renal outcome.
Collapse
Affiliation(s)
- Michele Torre
- Pediatric Surgery Unit, G. Gaslini Institute, Genova, Italy.
| | | | | | | | | | | | | |
Collapse
|
19
|
Mourtzinos A, Stoffel JT. Management goals for the spina bifida neurogenic bladder: a review from infancy to adulthood. Urol Clin North Am 2010; 37:527-35. [PMID: 20955904 DOI: 10.1016/j.ucl.2010.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with spina bifida require longitudinal urological care as they transition from childhood to adolescence and then to adulthood. Issues important to urological health, such as protection of the upper tracts and prevention of incontinence, need vigilant follow-up throughout the patient's life. As the child ages, additional issues such as sexual functioning also become increasingly important for social integration. Despite this need for regular assessment, many adult patients with spina bifida lose coordinated urological care after leaving specialized pediatric spina bifida clinics. Consequently, urologists frequently encounter an adult patient with spina bifida in practice and they need to understand the basic urological treatment goals and potential complications for this population.
Collapse
Affiliation(s)
- Arthur Mourtzinos
- Department of Urology, Lahey Clinic, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA
| | | |
Collapse
|
20
|
Thorup J, Biering-Sorensen F, Cortes D. Urological outcome after myelomeningocele: 20 years of follow-up. BJU Int 2010; 107:994-9. [PMID: 20860652 DOI: 10.1111/j.1464-410x.2010.09681.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE • To evaluate the urological outcome in a long-term follow-up of individuals with myelomeningocele and relate the findings obtained to urodynamic variables in childhood. PATIENTS AND METHODS • Individuals with myelomeningocele born from 1964-1988 were included at time of urodynamic investigation. • Age at inclusion was in the range from 1 month to 19.5 years (median, 6 years). • Detrusor function was classified as overactive, underactive or non-contractile. • Urethral function was classified according to the leak point pressure. • In childhood and at follow-up, kidney function was estimated with renography and isotope-glomerular filtration rate examinations. RESULTS • In total, 52 individuals (28 boys and 24 girls) aged 19-41 years (median, 29 years) had follow-up. • Of these, 37 (71%) individuals had bilateral normal kidney function at follow-up; seven (14%) had normal total renal function but unilateral deteriorated kidney, and eight individuals (15%) had deteriorated kidney function. • Adult individuals with bilateral kidney deterioration had a significant higher frequency of diagnosed detrusor overactivity at childhood urodynamics (63%) compared to those with normal function of both kidneys (24%). In total, 48% of the 52 myelomeningocele individuals were continent at follow-up. • Continence surgery was performed in eight patients, nine used anticholinergica, three had regular botulinum toxin detrusor injections, and 27 used clean intermittent catheterization. CONCLUSIONS • Overall, 15% of patients had impairment of kidney function and 48% were urinary continent. • Considering the present age distribution of the present study population, this figure appears to be comparable to the data in the literature. • Urodynamic findings in childhood were predictive for later kidney deterioration.
Collapse
Affiliation(s)
- Jorgen Thorup
- Department of Pediatric Surgery and Clinic for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark.
| | | | | |
Collapse
|
21
|
Fägerskiöld A, Mattsson GG. Disabled children and adolescents may be outsiders in the community. Int Nurs Rev 2010; 57:470-7. [DOI: 10.1111/j.1466-7657.2010.00810.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Borg H, Holmdahl G, Olsson I, Wiklund LM, Sillén U. Impact of spinal cord malformation on bladder function in children with anorectal malformations. J Pediatr Surg 2009; 44:1778-85. [PMID: 19735825 DOI: 10.1016/j.jpedsurg.2009.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 03/02/2009] [Accepted: 03/02/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Risk factors for the presence of neurogenic bladder dysfunction (NBD) in children born with high anorectal malformations (ARMs), were investigated, to identify the need for urodynamics in these patients. MATERIAL AND METHODS The study included 37 patients with high ARMs (21 boys and 16 girls). Bladder function was evaluated with urodynamics both before and after anorectoplasty (posterior sagittal anorectoplasty [PSARP]). All patients were investigated with spinal radiograph. Spinal ultrasound was performed in the neonatal period, and magnetic resonance imaging was added in case of abnormal ultrasound or urodynamics and in case of cloacal malformation. RESULTS In ARM patients with rectourethral and vestibular fistulas and cloacas, NBD was identified in 9 children (25%). The bladder dysfunction was innate in all cases except in one girl with cloaca, indicating that the risk of iatrogenic denervation seems minimal using the PSARP technique. All children with innate NBD had a spinal cord malformation either as spinal cord regression or tethering with or without a lipoma. Concerning vertebral status, almost all children with NBD had partial sacral agenesis. Abnormal perineal appearance was highly correlated to NBD in boys, especially in those with a spinal cord regression malformation. Innate NBD was not found in any child with normal spinal cord. CONCLUSION From these results, we suggest that spinal ultrasound and perineal inspection are used as screening procedures for NBD in children with ARM. Urodynamic investigation is recommended only when spinal cord anomalies or other signs indicative of NBD are present. In case of spinal cord malformation, repeated urodynamics during follow-up is mandatory because of the risk for developing tethered cord syndrome.
Collapse
Affiliation(s)
- Helena Borg
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden.
| | | | | | | | | |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW To review the most current literature regarding the management of neurogenic bladder in children. RECENT FINDINGS Several recent papers have addressed the investigation and management of children with neurogenic bladder. Bladder wall thickness as measured by ultrasound may identify the children with urodynamic risk factors for upper urinary tract deterioration. Strategies such as maximal anticholinergic therapy, total endoscopic management, conservative management throughout puberty, and isolated bladder neck procedures to avoid bladder augmentation show promise. However, at present, there is inadequate long-term follow-up to recommend widespread application of all of these approaches. As children with neurogenic bladder enjoy longer life spans, issues including risks of malignancy related to augmentation and transition to adult-centered care will continue to gain significance. SUMMARY Pediatric urologists continue to face many challenges in the management of children with neurogenic bladder. This includes identifying predictors of upper urinary tract deterioration, finding efficacious strategies to avoid bladder augmentation, and long-term care. The most recent literature attempts to address these issues. Further prospective studies with adequate follow-up will benefit our understanding of this disease process and help to choose the best strategies to achieve continence and preserve renal function in this population.
Collapse
|