The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood.
BackgroundThe incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida and the authors of this study sought to determine the effects of untethering on the urological outcome of children with a tethered cord and thus identifying proper urological management for individuals with spina bifida. MethodsDemographic and clinical data were collected via an online questionnaire and convenient sampling technique were used. 49 spina bifida individuals participated in this study. ResultsThe diagnosis of UTIs is dependent on patients reporting cloudy and smelly urine (67%) and urine validation (60%). 18% of the respondents claimed to have been prescribed antibiotics even though they had no history of UTI. Indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of UTI. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0 – 35 years of age). All individuals below the age of 5 (n=14) had improved urological outcome due to the untethering surgery under the guidance of the Malaysia NTD support group. ConclusionSpina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatment being instigated soon after birth and continuing into adulthood.
Background The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida and the authors of this study sought to determine the effects of untethering on the urological outcome of children with a tethered cord and thus identifying proper urological management for individuals with spina bifida. Methods Demographic and clinical data were collected via an online questionnaire and convenient sampling technique were used. 49 spina bifida individuals participated in this study. Results The diagnosis of UTIs is dependent on patients reporting cloudy and smelly urine (67%) and urine validation (60%). 18% of the respondents claimed to have been prescribed antibiotics even though they had no history of UTI. Indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of UTI. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0 – 35 years of age). All individuals below the age of 5 (n=14) had improved urological outcome due to the untethering surgery under the guidance of the Malaysia NTD support group. Conclusion Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatment being instigated soon after birth and continuing into adulthood.
The occurrence of neuroinflammation after the failure of neural tube closure, resulting in spina bifida aperta, is well established but whether or not neuroinflammation contributes to damage to the neuroepithelium prior to and during closure is not known. Neuroinflammation may occur at different time periods after perturbation to the developing spinal cord. Evidence suggests that early neuroinflammation is detrimental, whereas the later chronic phase of neuroinflammation may have useful roles. The role of neuroinflammation in neural tube defects is complex. It is important to make the distinction of whether neuroinflammation is important for neuroprotection or detrimental to the neural tissue. This may directly be influenced by the location, magnitude and duration of the insult, as well as the expression of neurotrophic or neurotoxic molecules. The current understanding remains that the chronic damage to the developing spinal cord is likely due to the chemical and mechanical damage of the exposed neural tissue owing to the aggressive intrauterine environment, described as the “two-hit mechanism”. Astrogliosis in the exposed spinal cord has been described in animal models of spina bifida after the failure of closure during embryonic life. Still, its association with neuroinflammatory processes is poorly understood. In this review, we will discuss the current understanding of neuroinflammation in neural tube defects, specifically spina bifida, and highlight inflammation-targeted strategies that may potentially be used to treat this pathophysiological condition.
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