“Closed” External Sphincterotomy for Bladder Outlet Obstruction in Myelomeningocele

Thomas, Gareth G.; Zachary, R.B.; Lister, James

doi:10.1111/j.1464-410x.1973.tb06814.x

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…relaxation of the sphincter muscle during contraction of the detrusor). This detrusor sphincter dyssynergia always suggests the possibility of a functional obstruction at the level of the external urethral sphincter (Cooper 1968, Stark 1969Tanagho et al 1971;Plasman and Donker 1972;Thomas et al 1973).…”

Section: Classification and Resultsmentioning

confidence: 98%

Measurement of Intravesical and Rectal Pressures Simultaneously with Electromyography of Anal Sphincter in Children with Myelomeningocele

Gool

Ridder

Kuijten

et al. 1976

Develop Med Child Neuro

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SUMMARY This paper reports a technique for simultaneous measurement of intravesical pressure, intra‐abdominal pressure, electromyographic activity of the external anal sphincter and urinary flow. Using this technique during filling of the bladder and during micturition in 38 children with myelomeningocele and neurogenic bladder disturbance, it was possible to identify four main types of bladder dysfunction in these children. Once the type of bladder dysfunction is established for each child, adequate management can be planned far in advance of the detection of inherent upper urinary tract damage. This is particularly important in children with upper somatomotor neuron lesions of bladder innervation in which detrusor‐sphincter dyssynergia may be present; this dyssynergia always causes some degree of obstruction at the level of the external urethral sphincter and is a constant threat to renal function. RÉSUMÉ L'article rapporte une technique d'une mesure simultanée de la pression intra‐vésicale, de la pression intra‐abdominale, de l'activité EMG du sphincter anal externe et du flux urinaire. En utilisant cette technique durant le remplissage de la vessie et durant les mictions, chez 38 enfants porteurs d'un myélomeningocèle avec vessie neurologique, il a été possible d'identifier quatre types principaux de dysfonctionnement vésicale chez ces enfants. Une fois le type de dysfonctions vésicale bien établi pour chaque enfant, un traitement adapté peut être prévu bien avant la détection des lésions du tractus urinaire. Ceci est particulièrement important dans le cas des lésions somato‐moteurs centrales de l'innervation vésicale dans lesquelles on peut observer une asynergie vesico‐sphincterienne; cette asynergie provoque une certain degré d'obstruction au niveau du sphincter urethral externe et constitue une menace constante pour la fonction rénale. ZUSAM MENFASSUNG Diese Arbeit berichtet über eine Methode zur simultanen Messung des intravesikalen und intraabdominellen Druckes, der EMG‐Aktivität des Sphinkter ani externus und des Urinjlusses. Unter Anwendung dieser Technik während des Füllens der Blase und der Miktion bei 38 Kindern mit Myelomeningocele und neurogenen Blasenstörungen war es möglich, vier Haupttypen einer Blasenfehlfunktion bei diesen Kindern zu identiflzieren. Wenn erst der Typ der Blasenfunktionsstörung bei jedem Kind festgestellt ist, kann eine adäquate Behandlung geplant werden weit vor der Feststellung eines inherenten Schadens der oberen Harnwegen. Dies ist besonders wichtig bei Fällen mit einer Läsion des oberen somatomotorischen Neurons der Blaseninnervation, bei der ein fehlerhafter Detrusor‐Sphinkter‐Synergismus vorhanden sein kann; diese Dyssynergie verursacht immer eine gewisse Obstruktion in Höhe des Sphinkter externus und stellt eine dauernde Bedrohung der Nierenfunktion dar. RESUMEN Esta comunicación aporta una técnica para la medición simultánea de la presiones intravesical e intraabdominal, así como de la actividad EMG del esfínter anal externo y del flujo urinario. Utilizando esta técn...

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Section: Classification and Resultsmentioning

confidence: 98%

Measurement of Intravesical and Rectal Pressures Simultaneously with Electromyography of Anal Sphincter in Children with Myelomeningocele

Gool

Ridder

Kuijten

et al. 1976

Develop Med Child Neuro

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“…In older children with big, dilated ureters and deteriorating renal function, accompanied by reflux, in whom antireflux surgery would be difficult or hazardous, we are hesitant to recommend intermittent catheterisation since if done infrequently, it may be followed by severe pyelonephritis or gram negative shock, resulting in acute or chronic renal failure (8,9,11). In these eircumstances, alternative surgical procedures should be considered, such as external sphincterotomy in boys, transurethral resection of the bladder neck, or urethral dilatation or urethrotomy in girls (18,20,25,26). However, such surgery may not produce dramatic results in those children with both dilatation and reflux (25).…”

Section: Discussionmentioning

confidence: 99%

Urinary Catheters in Spina Bifida

Gohary¹,

Brereton²,

Lister³

1982

Eur J Pediatr Surg

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Since 1974, 56 children with a neuropathic bladder were selected for intermittent or indwelling catheterisation. Indications for catheterisation included incontinence, hydronephrosis, and/or difficulty with bladder expression. Good results were obtained in 70% of girls and 50% of boys. The catheter was abandoned in 7 children, mainly because of lack of cooperation from the parents. Deterioration occurred only in those children with both hydronephrosis and vesico-ureteric reflux prior to catheterisation. Of the latter group of children, 33% suffered upper tract deterioration, and we now consider vesico-ureteric reflux to be a relative contra-indication to catheterisation, except in those children with severe disabilities and deformities, in whom antireflux surgery or urinary diversion would be unacceptable or technically difficult. Indwelling penile catheters should not be recommended for boys, but catheterisation via a perineal urethrostomy may prove helpful in those unable either to catheterise themselves intermittently or to wear a penile appliance.

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“…Such surgery may include external sphincterotomy in boys (Thomas et al, 1973) or urethral dilatation or urethrotomy in girls, and though these measures cannot be guaranteed to achieve satisfactory emptying of the bladder they may prevent further deterioration for a time.…”

Section: Discussionmentioning

confidence: 99%

Urinary continence in open myelomeningocele.

Brereton¹,

Zachary²,

Lister³

1977

Archives of Disease in Childhood

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In a consecutive series of 200 neonates having undergone surgery for open myelomeningocele, 24 of the 106 survivors at 10 to 12 years of age proved to be continent of urine. These figures included 11 children who had considerable neurological involvement. 4 children did not acquire urinary control until after the age of 5 years. Therefore, we consider early urinary diversion in children with myelomeningocele, even in the presence of neurological deficit, to be indicated only for the prevention of progressive deterioration in renal function. Incontinence of urine itself is not an indication for urinary diversion in the first decade of life.

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“Closed” External Sphincterotomy for Bladder Outlet Obstruction in Myelomeningocele

Cited by 5 publications

References 4 publications

Measurement of Intravesical and Rectal Pressures Simultaneously with Electromyography of Anal Sphincter in Children with Myelomeningocele

Measurement of Intravesical and Rectal Pressures Simultaneously with Electromyography of Anal Sphincter in Children with Myelomeningocele

Urinary Catheters in Spina Bifida

Urinary continence in open myelomeningocele.

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