Bladder-sphincter dysfunction in myelomeningocele

Gool, Jan D. van; Dik, Pieter; Jong, Tom P.V.M. de

doi:10.1007/s004310100741

Cited by 78 publications

(36 citation statements)

References 56 publications

(54 reference statements)

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“…After the neonatal period, 50 % of patients will have bladder/sphincter dyssynergy, and pelvic floor activity and the detrusor activity can be abnormal (hyperactive or inactive), which are completely independent from each other [85]. This results in a functional obstructive uropathy and potentially places the upper tracts at risk of hydronephrosis, urinary infection, and renal insufficiency.…”

Section: Therapeutic Intervention For Neurogenic Bladdersmentioning

confidence: 96%

Pediatric Bladder Disorders

Bérard

2014

Pediatric Nephrology

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Section: Therapeutic Intervention For Neurogenic Bladdersmentioning

confidence: 96%

Pediatric Bladder Disorders

Bérard

2014

Pediatric Nephrology

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“…Neuropathic bladder is a known complication of this open NTD. Pediatric urodynamic studies have shown that detrusor and urethral sphincter activity can be abnormal (hyperactive or inactive), completely independent of each other [2] . This detrusor-sphincter dyssynergia can create a functional bladder outlet obstruction in children with meningomyelocele, acting like an anatomical urethral obstruction.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Urinary Ascites in a Fetus with Meningomyelocele

2010

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Fetal or neonatal urinary ascites is a rare phenomenon, particularly when secondary to rupture of a neuropathic bladder in a fetus with meningomyelocele. To date, all similar cases have only been diagnosed in the neonatal period. We report a case of urinary ascites secondary to rupture of a neuropathic bladder, which was successfully diagnosed via fetal paracentesis at 37 weeks. The infant was delivered by elective cesarean section and managed immediately with therapeutic paracentesis and bladder catheterization. Voiding cystourethrogram on the fifth day of life showed the bladder had spontaneously healed. Early diagnosis and prompt intervention for bladder complications diagnosed in utero may prevent or minimize adverse consequences.

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“…[17] and by Van Gool et al . [18] showed that 60-65% of children with neuropathic bladder dysfunction have sphincter activity with or with no associated DO. The response of the NB in the absence of cortical inhibition to this form of outlet resistance is the development of detrusor hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

et al. 2007

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OBJECTIVE To evaluate whether the degree of preoperative bladder trabeculation in neurogenic bladder (NB) patients is a marker of significant outlet resistance. If so, severe trabeculation may obviate the need for concomitant bladder outlet procedure (BOP) during augmentation cystoplasty (AC). PATIENTS AND METHODS We retrospectively reviewed 48 incontinent patients with NB who had surgery. The patients were divided into two groups: group 1 (23 patients) had AC alone; group 2 (10) had AC with BOP. Children who had a BOP alone (15) were excluded from the study. Success was defined as a dry period of ≥4 h. Preoperative bladder trabeculation was classified as mild or severe. Data collected included continence status, imaging and urodynamic findings. RESULTS In group 1 patients before surgery, there was severe bladder trabeculation in 14 (61%), hydronephrosis in 13 (57%) and associated vesico‐ureteric reflux (VUR) in 16 (70%). The mean detrusor leak‐point pressure (DLPP) was 49.7 cmH2O and the bladder neck was open in nine (39%). Dryness with AC alone was achieved in 91% of group 1 patients. In group 2 patients (10 patients), there was severe bladder trabeculation in five, hydronephrosis in three, and VUR in two. The mean DLPP was 42.8 cmH2O and the bladder neck was open in eight. After surgery, eight of 10 patients achieved a dry period of 4 h. There was no significant difference between group 1 and 2 patients for age at surgery, gender, ambulatory status, hydronephrosis, degree of trabeculation, detrusor overactivity, DLPP and eventual outcome. The incidence of VUR was higher in group 1 patients (P = 0.009) and more patients in group 2 had an open bladder neck (P = 0.031). CONCLUSION Severe bladder trabeculation in incontinent patients with NB might predict an element of intrinsic outlet resistance. In this subset of patients, dryness was achieved by AC alone without further BOP. The degree of bladder trabeculation should be considered in the surgical decision‐making process for incontinent children with NB.

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Bladder-sphincter dysfunction in myelomeningocele

Cited by 78 publications

References 56 publications

Pediatric Bladder Disorders

Pediatric Bladder Disorders

Prenatal Diagnosis of Urinary Ascites in a Fetus with Meningomyelocele

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

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