After failure of conservative treatment in patients with neurogenic bladder urinary diversion represents a safe long-term compromise. Daytime and nighttime continence is provided by the Mainz pouch bladder substitution and urinary diversion, while the upper urinary tract is protected by antireflux ureteral implantation.
The treatment of children and adolescents with meningomyelocele has experienced a clear change in the last 30 years. The establishment of pharmacotherapy, clean intermittent catheterization (CIC) and infection prophylaxis have improved the prognosis for patients and have led to new therapeutic strategies. The interdisciplinary cooperation between neonatologists, neurosurgeons, pediatric neurologists, pediatric urologists, pediatric nephrologists, pediatric orthopedists and pediatric surgeons leads to optimization of individualized therapy. These guidelines present definitions and classifications, investigations and timing which are described in detail. The conservative and operative therapy options for neurogenic bladder function disorders are described and discussed with reference to the current literature. The brief overview provides in each case assistance for the treating physician in the care of this patient group and facilitates the interdisciplinary cooperation.
Since the 1980s the management of children and adolescents with meningomyelocele has undergone major changes. The introduction of pharmacotherapy with antimuscarinic agents, clean intermittent catheterization (CIC) and antibacterial prophylaxis has revolutionized the management of children with neurogenic bladder. The co-operation between neonatologists, neurosurgeons, paediatric neurologists, paediatricians, paediatric urologists, paediatric nephrologists, paediatric orthopaedists and paediatric surgeons is necessary to achieve an optimized therapy in each individual patient. In this interdisciplinary consensus paper we provide definitions and classifications as well as a timetable for the appropriate investigations. The conservative and surgical options are explained in detail. A short review is given concerning orthopaedic management, incidence of latex allergy, options for bowel management, diagnosis and treatment of urinary tract infections, problems with sexuality and fertility as well as the long-term compliance of these patients and their relatives.
Itisto]ogical findings in four human embryos are described, whose mothers suffered from virus-hepatitis during the first trimenon of pregnancy. Destructions of the vessels (umbilical vein, aorta, carotic arteries, superior vena cava) and the endocardinm were found. ~rom these lesions necrotical material was transported into the brain, the kidney, and the intestinal-tract. The histological structure of the brain, the musculature, the spinal-cord, and the lungs was found to be changed. The nucleus of the crystallinelens was destroyed. Other organs showed no alterations. Multinucleated giant cells were seen in the liver, in the heart, in the lungs, in the brain, of all four embryos near the necrotic tissue.The effect of the hepatitis-virus on cells, the way of infection, the origin of the multinucleated giant cells, the observed hemorrhagic diathesis and the malformations, caused by the hepatitis-virus are discussed. The results are compared with the embryopathia rubeolica arid other virus diseases.
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