Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach

Goldfarb, Robert; Pisansky, Andrew; Fleck, Joseph; Hoversten, Patrick; Cotter, Katherine; Katorski, Jenna; Liberman, Daniel; Elliott, Sean P.

doi:10.1016/j.juro.2015.10.085

Cited by 19 publications

(5 citation statements)

References 9 publications

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“…The high incidence of urinary incontinence in the general CP population is likely due to uninhibited neurogenic bladder. In CP patients, the normal inhibitory control of the central nervous system detrusor function is impaired or underdeveloped, resulting in urgency or enuresis [19]. …”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

Park

Liu

Edwards

et al. 2017

Cureus

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BackgroundSelective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated.ObjectivesTo evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR.MethodsAdult patients who received SDR in childhood were surveyed. The survey questionnaire asked about demographic information, quality of life, health outcomes, SDR surgical outcomes, ambulation, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, and work status.ResultsOur study included 95 patients. The age that patients received SDR was between two and 18 years. The age at the time of survey was between 23 and 37 years (mean ± S.D., 30.2 ± 3.6 years). Post-SDR follow-up ranged from 20 to 28 years (mean ± S.D., 24.3 ± 2.2 years). Seventy-nine percent of patients had spastic diplegia, 20% had spastic quadriplegia, and one percent had spastic triplegia. Ninety-one percent of patients felt that SDR impacted positively the quality of life and two percent felt that the surgery impacted negatively the quality of life after SDR. Compared to pre-operative ambulatory function, 42% reported higher level of ambulation and 42% ambulated in the same level. Eighty-eight percent of patients would recommend the procedure to others and two percent would not. Thirty-eight percent reported pain, mostly in the back and lower limbs, with mean pain level 4.2 ± 2.3 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in patchy areas of the lower limbs that did not affect daily life was reported by eight percent of patients. Scoliosis was diagnosed in 31%. The severity of scoliosis is unknown. Only three percent of them underwent spinal fusion. Fifty-seven percent of patients required some orthopedic surgery after SDR. The soft-tissue tendon lengthening procedures included lengthening on hamstrings, Achilles tendons or adductors. Out of all bone procedures, 24% of patients had hip surgery, five percent had knee surgery, and 10% had derotational osteotomies. No late side effects of SDR surgery were reported in this survey.ConclusionsIn our 95 adult patients who received SDR in childhood, the surgery had positive effects on the quality of life and ambulation 20-28 years later. There were no late complications of SDR surgery.

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Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

Park

Liu

Edwards

et al. 2017

Cureus

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“…A large capacity bladder without detrusor overactivity is therefore counterintuitive. Yet, in the presence of chronic outlet obstruction from pseudodyssynergia, the bladder develops detrusor myogenic failure, which can mimic a lower motor neuron flaccid bladder . We have previously shown that 16% of all adult patients with CP undergoing urodynamic evaluation at our clinic have such a finding, with bladder capacity >600 mL and compliance >20 ml/cm H2O .…”

Section: Discussionmentioning

confidence: 91%

“…These symptoms can be a source of significant distress to patients and caregivers and have an adverse impact on quality of life . Given the unique challenges of patients with CP, incontinence is often challenging to categorize as either storage‐ or emptying‐predominant . Urodynamics most often reveals findings typical of a suprapontine lesion: NDO without true detrusor‐sphincter dyssynergia.…”

Section: Introductionmentioning

confidence: 99%

Bladder changes after catheterizable channel creation in adults with cerebral palsy who are in chronic urinary retention

Narayan

Pariser

Gor

et al. 2018

Neurourology and Urodynamics

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Aims: Cerebral palsy (CP) is characterized by motor impairments as a result of brain injury during development. Patients can have neurogenic bladder dysfunction and are often unable to catheterize through their native urethra. Catheterizable channel (CC) creation can facilitate clean intermittent catheterization (CIC). We have observed that patients with large capacity, low-pressure bladders can develop de novo neurogenic detrusor overactivity (NDO) postoperatively. We sought to better characterize this finding. Methods: We reviewed the charts of patients 17 years or older with CP seen between 2006 and 2017. Patients undergoing creation of any type of CC without augmentation cystoplasty, due to adequate storage on pre-operative urodynamics (UDS), were included. Pre-and post-operative UDS were reviewed. Frequency of incontinence and use of anticholinergics or intravesical injections of onabotulinum toxin A (Btx) were reviewed. Results: Eight patients with CP underwent CC creation without augmentation. Preoperatively, six of eight patients were in chronic retention with two others performing CIC. Following CC creation, patients in retention required additional NDO management with anticholinergics, mirabegron, or onabotulinumtoxin A. Among those with complete UDS data, 67% demonstrated lower maximum cystometric capacity postoperatively. Median follow-up was 25 months. Conclusions: CC creation facilitates CIC in adults with CP who are in chronic retention due to pseudodyssynergia. Despite preoperative UDS suggesting an adequate capacity, low-pressure bladder, such patients often manifest de novo NDO and worsening incontinence upon initiation of CIC after surgery. These findings should be considered when determining whether to perform augmentation at the time of CC in adults with CP. K E Y W O R D S augmentation cystoplasty, bladder augmentation, catheterizable channel, cerebral palsy, chronic urinary retention, neurogenic bladder, neurogenic detrusor overactivity

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“…Upon review of clinic notes for the patient who developed urinary incontinence after SDR, it was found that no significant urinary control problems were indicated after SDR. Some patients with cerebral palsy can suffer from neurogenic bladder and incontinence even without SDR [10]. The incontinence occurred long after SDR in the patient.…”

Section: Resultsmentioning

confidence: 99%

Functional Outcome of Adulthood Selective Dorsal Rhizotomy for Spastic Diplegia

Park¹,

Uhm²,

Walter³

et al. 2019

Cureus

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ObjectiveThe medical evidence supporting the efficacy of selective dorsal rhizotomy (SDR) on children with spastic diplegia is strong. However, the outcome of SDR on adults with spastic diplegia remains undetermined. The aim is to study the effectiveness and morbidities of SDR performed on adults for the treatment of spastic diplegia. MethodsPatients who received SDR in adulthood for the treatment of spastic diplegia were surveyed. The survey questionnaire addressed the living situation, education level, employment, health outcomes, postoperative changes of symptoms, changes in ambulatory function, adverse effects of SDR and orthopedic surgery after SDR. ResultsThe study included 64 adults, who received SDR for spastic diplegia. The age at the time of surgery was between 18 and 50 years. The age at the time of the survey was between 20 and 52 years. The follow-up period ranged from one to 28 years. The study participants reported post-SDR improvements of the quality of walking in 91%, standing in 81%, sitting in 57%, balance while walking 75%, ability to exercise in 88%, endurance in 77%, and recreational sports in 43%. Muscle and joint pain present before surgery improved in 64% after surgery. Concerning the level of ambulatory function, all patients who walked independently in all environments maintained the same level of ambulatory function. Eighteen percent of the patients who walked independently in some environments improved to the independent walking in all environments. All patients who walked with an assistive device before SDR maintained the assistive walking after SDR. Concerning adverse effects of SDR, 50% (32 of 64 patients) developed numbness in the various parts of the legs. Two patients reported a complete loss of sensation in parts of the legs, and one patient reported numbness and constant pain in the bilateral lower extremities. Ten patients (16%) reported recurrent spasticity after SDR, and three patients (5%) reported ankle clonus, which is an objective sign of spasticity. Tendon lengthening surgery after SDR was needed in 27% and hip and knee surgery in 2% and 6%, respectively. ConclusionsThe great majority of our 64 patients, who received adulthood SDR for spastic diplegia, improved the quality of ambulation and abated signs of early aging. Numbness and diminished sensation in the lower extremity was the most common adverse effect of the adulthood SDR.

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Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach

Cited by 19 publications

References 9 publications

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

Bladder changes after catheterizable channel creation in adults with cerebral palsy who are in chronic urinary retention

Functional Outcome of Adulthood Selective Dorsal Rhizotomy for Spastic Diplegia

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