Early Start to Therapy Preserves Kidney Function in Spina Bifida Patients

Dik, Pieter; Klijn, Aart J.; Gool, Jan D. van; Steenwijk, Catherine C.E. de Jong-de Vos van; Jong, T. P. V. M. de

doi:10.1016/j.eururo.2005.12.056

Cited by 204 publications

(119 citation statements)

References 22 publications

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“…It was the conclusion of these authors that expectant therapy could no longer be advocated when 'at risk' infants are identified, as the prophylactic treatment is so effective [Kasabian et al 1992]. Subsequently, this strategy has been confirmed to also preserve renal function [Dik et al 2006]. In addition, the Boston group assessed urological outcomes in patients with myelodysplasia who were documented to have high-risk bladders in infancy due to the presence of DSD or high filling or voiding pressure.…”

Section: Neurogenic Bladdermentioning

confidence: 99%

Best practice in the assessment of bladder function in infants

Guerra

Leonard

Castagnetti

2014

Therapeutic Advances in Urology

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Abstract:The purpose of this article is to review normal developmental bladder physiology in infants and bladder dysfunction in conditions such as neurogenic bladder, posterior urethral valves and high grade vesicoureteric reflux. We contrast the classical concept that bladder function in nontoilet-trained children is thought to be 'reflexive' or 'uninhibited', with the results of more recent research showing that infants most commonly have a stable detrusor. The infant bladder is physiologically distinct from the state seen in older children or adults. The voiding pattern of the infant is characterized by an interrupted voiding stream due to lack of proper urinary sphincter relaxation during voiding. This is called physiologic detrusor sphincter dyscoordination and is different from the pathologic 'detrusor sphincter dyssynergy' seen in patients with neurogenic bladder. Urodynamic abnormalities in neonates born with spina bifida are common and depend on the level and severity of the spinal cord malformation. Upper neuron lesions most commonly lead to an overactive bladder with or without detrusor sphincter dyssynergy while a lower neuron lesion is associated with an acontractile detrusor with possible denervation of the external urinary sphincter. In infants with neurogenic bladder, the role of 'early prophylactic treatment (clean intermittent catheterization and anticholinergics)' versus initial 'watchful waiting and treatment as needed' is still controversial and needs more research. Many urodynamic-based interventions have been suggested in patients with posterior urethral valves and are currently under scrutiny, but their impact on the long-term outcome of the upper and lower urinary tract is still unknown. Cumulative data suggest that there is no benefit to early intervention regarding bladder function in infants with high-grade vesicoureteric reflux.

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Section: Neurogenic Bladdermentioning

confidence: 99%

Best practice in the assessment of bladder function in infants

Guerra

Leonard

Castagnetti

2014

Therapeutic Advances in Urology

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“…Cortical damage was seen in 13.3% of children with SB under the age of 2, whereas it was in 27.3% of children with SB over the age of 10. In the follow-up of SB, they trusted the reliability of renal US without the need of scintigraphy if serum creatinine, US, and bladder pressure were all normal (13). However, in their recent study with adult SB patients, Veenboer et al (14) compared both modalities with a focus on renal scarring and concluded that renal scars are often missed with US.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina Bifida

Özgönenel¹,

Karalök²,

Günay³

et al. 2017

Istanbul Med J

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Spina bifida (SB) refers to a wide range of neural tube defects, a neuro-urological disease affecting the spine and spinal cord. With a marked geographic and ethnic variation, SB has an incidence of 1-5 cases per 1000 live births. In Turkey, the incidence is 3 per 1000 live births (1), and in the eastern region of Turkey, it is 2.2 per 1000 live births (2). The basic urological problem in SB is neurogenic bladder dysfunction, resulting in urinary tract infections (UTI), incontinence, vesicoureteral reflux (VUR), hydronephrosis, chronic kidney disease (CKD), hypertension, and end-stage renal failure (3). The goal of treatment is to reduce bladder pressure and minimize urine stasis, thus preventing recurrent febrile UTI and consequent function loss. Patients should be followed up regularly against late referral because SB management is a dynamic and long-lasting process for a life time, and patient selection for aggressive treatment may prevent renal parenchymal deterioration (4).Although renal ultrasonography (US) is used to demonstrate renal anomalies, urinary tract dilatation, signs of neurogenic bladder, renal scarring, and presumed function of the kidney, Tc99m DMSA scintigraphy is the best for detecting renal parenchymal defects and demonstrating renal function loss with decreased differential function of the kidney. Single defects resulting in a localized deformity of renal outlines are the result of scarring and show no improvement on subsequent studies. The total renal Dimercaptosuccinic acid (DMSA) uptake is a measure of individual renal function (5). Follow-up studies with scintigraphy and US are conducted to confirm the resolution of pyelonephritic defect(s), evaluation of cortical scarring, and function loss. Patients with scarring are periodically followed up for assessment of progressive renal insufficiency. Tc-99m DMSA scintigraphy demonstrates approximately twice as many defects as renal US in the normal population (6). We hypothesized that this proportion may increase in SB patients because SB patients usually have rotoscoliosis, obesity, renal position anomalies, and intestinal gas distention that may corrupt the imaging quality of US, whereas these imaging difficulties do not affect the imaging quality of Tc-99m DMSA scintigraphy. We studied the efficiency of Tc-99m DMSA scintigraphy and renal US in the detection of renal scarring and function loss in children with SB. Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina BifidaObjective: We aimed to compare the sensitivity of ultrasonography (US) and Dimercaptosuccinic acid (DMSA) scintigraphy in evaluating renal scarring and kidney function in children with spina bifida (SB). Methods:The study group comprised 100 patients (51 boys and 49 girls) with SB who underwent renal US and DMSA scintigraphy. The median age was 2 years (range: 6 months -23 years). Renal US scans were performed by applying standard protocols. Subsequently, DMSA scintigraphy was performed to e...

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“…Current medical treatment provides the opportunity to convert a high-pressure bladder into a low-pressure reservoir that is safe for the upper urinary tracts. [4][5][6] CIC was introduced for maintaining low pressure in neurogenic bladders in 1972. [7][8][9] We have found resolution in all patients of Grade 1 VUR and in 3 patients of Grade 2 VUR.…”

Section: Discussionmentioning

confidence: 99%

Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country

et al. 2017

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Background: Meningomyelocele (MMC) and meningocele (MC) are the two most common types of neural tube defects (NTD) seen. Some of the problems associated with care of these patients are psychological stress is parents, average financial condition of caretakers, ignorance on the part of parents, local physicians for management of this condition, very few dedicated Spina bifida clinics and social stigma associated with this condition. The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care involving paediatric surgeon, paediatrician, nursing staff, occupational therapist, physiotherapist, social worker, parents and patients themselves. The aim of this study is to discuss our experience in initial management of meningomyelocele (MMC) and hydrocephalus and long-term management of bladder/bowel incontinence and foot deformity in a tertiary care hospital of a developing country. Methods: A retrospective nonrandomized observational study was conducted in the department of pediatric surgery at a tertiary hospital, from August 2008 to October 2015. Overall 145 patients of meningomyelocele were included in the study. Patients were managed according to our institution protocol. Results: 68.2% MMC patients were repaired primarily. 24.1% of total patients needed Y-V plasty skin advancement flap. 7.5% patients needed synthetic patch for dural closure. 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth. 5.5% patients were incontinent after MMC repair. 8.2% patients had decreased lower limb power after MMC repair. 28.9% patients needed VP shunt for gross hydrocephalus before MMC repair. 51.03% patients needed VP shunt after MMC repair. 20% patients did not require VP shunt in the present series. 13.1% patients in the present series had urinary incontinence. 11.03% patients had fecal incontinence. 73.6% patients with urinary incontinence were successfully managed with conservative treatment. 87.5% patients with fecal incontinence responded to conservative treatment. Bladder augmentation was done in 26.3% of neurogenic bladder dysfunction patients. 60% of these patients had dry interval of more than 4 hours. MACE was done in 12.5% of neurogenic bowel dysfunction patients. 2 patients required simultaneous bladder augmentation, Mitrofanoff's and MACE procedure. One of these patients achieved a dry interval of >4 hour. Conclusions: Successful rehabilitation of children with MMC can be achieved with parental education and support, dedicated clinicians, trained nursing staff, regular follow-up and low threshold for diagnosing clinical deterioration and proactive management to prevent further clinical deterioration.

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Early Start to Therapy Preserves Kidney Function in Spina Bifida Patients

Cited by 204 publications

References 22 publications

Best practice in the assessment of bladder function in infants

Best practice in the assessment of bladder function in infants

Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina Bifida

Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country

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