Lipomyelomeningocele for the urologist: Should we view it the same as myelomeningocele?

Yerkes, Elizabeth B.; Halline, Christopher; Yoshiba, Grace M.; Meyer, Theresa; Rosoklija, Ilina; Bowman, Robin; McLone, David G.; Cheng, Earl Y.

doi:10.1016/j.jpurol.2017.04.014

Cited by 12 publications

(3 citation statements)

References 19 publications

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“…For these children, the complications from SD may be severe, whereas the prognosis for most children is excellent (Macejko et al, 2007;Veenboer et al, 2013;White et al, 2015;Peyronnet et al, 2018). There is a need for prognostic factors, which have been hard to find (Yerkes et al, 2017) and we argue that VOP provides improved opportunities to detect NBSD in the asymptomatic child with closed spinal dysraphism. The other situation is when parents of a child with SD report wet diapers and only small volumes when performing CIC.…”

Section: Discussionmentioning

confidence: 91%

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

Wide

2020

Linköping University Medical Dissertations

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Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder and bowel dysfunction-with the risk of urinary tract infections, renal deterioration, urinary and fecal incontinence-that affects social participation and quality of life negatively. In newborns with SD, early detection of neurogenic bladder dysfunction and determination of post-void residual urine are required to determine the need of clean intermittent catheterization (CIC) and follow-up.The non-invasive method of four-hour voiding observation with provocation test (VOP) was used to evaluate bladder function in 50 newborn children with SD. Voiding patterns for the children were described and compared with those of 50 healthy newborns evaluated with VOP in an earlier study. Comparison revealed significant differences among several variables. In particular, leakage at provocation test and not voiding with a stream were common in newborns with SD but did not occur in healthy newborns. VOP is a non-invasive standardized method to determine residual urine in newborns with SD. It also adds information on voiding pattern, frequency, voiding with a stream and leakage at provocation.

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Section: Discussionmentioning

confidence: 91%

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

Wide

2020

Linköping University Medical Dissertations

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“…The early neuro-urological complication rate following partial resection is approximately 8% [2,18] however, late deterioration in urological function is common. In two recent studies concerning partial resection, CIC was required in 23% [19] and 19% [20] of all cases, increasing to 47% [19] and 54% [20], respectively, if just transitional lipomas were considered. The published literature suggests that once urologic abnormalities are present, they are frequently irreversible, and this has been the basis of one of the most cogent arguments favouring prophylactic surgery.…”

Section: Discussionmentioning

confidence: 99%

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience

et al. 2022

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Purpose In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and low surgical morbidity. We adopted this technique in 2011, and aim to describe our first results. Methods In this monocentric retrospective audit, we included dorsal, transitional, chaotic, and caudal-type lumbosacral lipomas. Exclusion criteria were previously operated lipomas, pure filar lipomas, and concomitant major congenital anatomical urogenital/gastrointestinal abnormalities. Neuro-uro-orthopaedic status at presentation and at three months, one year and last postoperative follow-up, intraoperative electrophysiology, and extent of resection were collected. Results From January 2011 to September 2019, 91 patients were operated (median age 2y2m; 63 transitional; 14 caudal; 8 dorsal; 6 chaotic). Preoperatively, 67% were symptomatic. Preoperative and one-year postoperative rates of impaired ambulation (44% to 43%), hypoesthesia (8% to 5%), urodynamic/uroradiological abnormalities (49% to 37%), and foot/ ankle deformities (8% to 5%) were comparable, whilst pain improved (25% to 5%) but catheterisation rates increased (21% to 36%). 23/92 (25%) suffered wound-related complications. 2/91 (2%) developed symptomatic re-tethering requiring second surgery. Mean cord/sac ratio was 0.47. 43% had > 20 mm 3 residual fat, which improved with increasing surgical experience. Conclusion Radical lipoma resection, guided by intraoperative neuromonitoring, with reconstruction of the neural placode and expansion duraplasty is technically feasible and results in low rates of late deterioration and re-tethering. Lipoma-type and pre-operative status are important outcome predictors. Operative risks are not insignificant. Future studies need to determine appropriate selection criteria for surgery.

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“…The role of surgery before manifestations of neurological symptoms surrounds controversies. 14,15 Kuklerni and colleagues quoted a 33% chance of deterioration of symptoms among those cases that were managed conservatively in comparison to 46% in surgically treated cases. 16 Researchers have pointed out that surgical outcomes of lipomyelomeningocele closely correlate with the pre-surgery functioning of the cases.…”

Section: Discussionmentioning

confidence: 99%

Early Neurological Outcome of Surgical Repair of Lipomyelomeningocele in Infants

Iqbal

Ijaz

Butt³

et al. 2021

Pak J Neurol Surg

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Objective: A prospective cohort study was aimed to evaluate the early neurological outcome of surgery among infants having lipomyelomeningocele. Material and Methods: The study was conducted at the Department of Pediatric neurosurgery, Children Hospital &The Institute of Child Health, Lahore from January 2019 to June 2019.A total of 50 pediatric patients, both male and female, aged 3 months to 1 year, with lipomyelomeningocele (symptomatic or asymptomatic) who presented to the out-patient department were included in the study. Group A included those cases who were aged <6 months and Group B were aged >6 months. All patients underwent standard surgical procedures for the treatment of lipomyelomeningocele. Results: Out of a total of 50 infants, there was 32 (64.0%) female. Overall, the mean age was 7.39 ± 2.63 months. The lumbar area having mass on the back was the most frequently seen in 23 (46.0%) infants. Group A included 20 (40.0%) infants while Group-B had 30 (60.0%). Low lying cord was the commonest neurological finding noted among 25 (50.0%). Complete Excision of Lipoma was done among 48 (96.0%) infants. Post-surgery, no significant difference was found on day-3 and day-10 between study groups (P > 0.05). Early outcome at 6-months intervals was found to be associated with significantly improved neurological function grades in Group-A (p = 0.030). Conclusion: Surgical management of lipomyelomeningocele is a safe procedure. An early treatment approach even in asymptomatic infants is recommended to reduce neurological deterioration.

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Lipomyelomeningocele for the urologist: Should we view it the same as myelomeningocele?

Cited by 12 publications

References 19 publications

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience

Early Neurological Outcome of Surgical Repair of Lipomyelomeningocele in Infants

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