Urologic Problems in Meningomyelocele

Carlson, Hjalmar E.

doi:10.1016/s0022-5347(17)63441-4

Cited by 20 publications

(8 citation statements)

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“…Nash (1957) has reviewed the methods used and recommends time training, manual expression and urinals. Since then little has been added to the discussion of therapeutic measures (Carlson 1966, Cooper 1968.…”

Section: Introductionmentioning

confidence: 99%

Continence Training of Children with Neurogenic Bladder Dysfunction

Nergårdh

Hedenberg

Hellström

et al. 1974

Develop Med Child Neuro

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SUMMARY Thirty children with neurogenic bladder dysfunction, mainly due to myelomeningocele, were included in a trial of continence training. The training programme consisted of bladder expression at fixed time‐intervals, supported by drug therapy. After two training periods about one‐half the children had become socially continent, i.e. had regular dry periods between micturition every third hour. With one exception, the other patients also showed improvement. Residual function within cord segments S2‐S4 and the patient's own motivation were prognostically favourable factors, but training could also produce good results in other cases. Psychological support and practical help from specially trained personnel are extremely important. RÉSUMÉ 30 enfants présentant un trouble vésical d'origine neurologique principalement dûà des myéloméningocèles ont été choisis pour une tentative d'éducation de la propreté. Le programme d'apprentissage consistait en evacuation vésicale à des intervalles de temps fixes, aidé par traitement médicamenteux. Après deux périodes d'apprentissage, la moitié environ des enfants sont devenus socialement continents, ayant des périodes sèches régulières entre mictions de 3 heures. En dehors d'un seul cas, les autres malades ont présenté quelques progrès. Une fonction résiduelle dans les segments médullaires de S2 à 24 et une bonne motivation du sujet ont été des facteurs de pronostic favorable mais l'éducation a pu dormer de bons résultats dans d'autres cas. Une aide psychologique et des soins pratiques à partir d'un personnel spécialement forme sont extrêmement importants. ZUSAMMENFASSUNG 30 Kinder mit neurogener Fehlfunktion der Blase, überwiegend infolge einer Myelomeningocele wurden für ein Kontinenztraining ausgesucht. Das Trainingsprogramm bestand aus dem Blaseausdrücken zu festgelegten Zeiten, unterstützt von medikamentöser Behandlung. Nach zwei Trainingsperioden war ungefähr die Hälfte aller Kinder gesellschaftsfähig kontinent geworden, d.h. batten reguläre Perioden des Trockenbleibens zwischen den Harnentleerungen jede dritte Stunde. Bis auf eine Ausnahme zeigten auch die anderen Patienten eine Besserung. Restfunktionen in den Segmenten S2‐S4 und die Motivation des Patienten waren prognostisch begünstigende Faktoren, aber das Training erbrachte auch in anderen Fallen gute Resultate. Psychologische Unterstützung und praktische Hilfe durch ein speziell ausgebildeates Personal sind äußerst wichtig. RESUMEN Treinta niños con disfunción vesical neurógena, debida sobre todo a un mielomeningocele, fueron seleccionados para un entrenamiento de continencia. El programa del entrenamiento consistió en una expresión vesical a intervalos fijos, con ayuda farmacológica. Después de dos períodos de entrenamiento, alrededor de la mitad de los niños eran socialmente continentes, es decir tenían períodos secos regulares entre micciones cada 3 boras. Con una excepción los otros pacientes también presentaban mejoría. La función residual entre los segmentos medulares S2 al S4 y la motivación del paciente e...

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Section: Introductionmentioning

confidence: 99%

Continence Training of Children with Neurogenic Bladder Dysfunction

Nergårdh

Hedenberg

Hellström

et al. 1974

Develop Med Child Neuro

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“…Carlson (1966) states that, in his series, 40% of the boys and 20% of the girls ultimately achieve some form of urinary control. However, the experience of most workers in this country is that the majority will be incontinent.…”

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confidence: 99%

Detrusor action in children with myelomeningocele.

Cooper¹

1968

Archives of Disease in Childhood

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About 3000 children a year are born in the United Kingdom with myelomeningocele (Eckstein and Macnab, 1966). Up to the present time attention has been focused on early closure of the back lesion, adequate and efficient drainage ofthe hydrocephalus, and management of the orthopaedic problems. It is now to be expected in our present series that 75 % of these children will be of normal intelligence, and most of them will walk, with the aid of calipers if necessary. Their major handicap as they approach school age will be their incontinence. In many instances this will prevent them attending normal schools.Figures concerning continence in these children vary widely. In a recent review of older patients Eckstein (1968) found that 30% were continent.He attributes the high continence rate in this series to the fact that these children, treated largely before the impact of modem treatment, represent a highly selected group. Carlson (1966) states that, in his series, 40% of the boys and 20% of the girls ultimately achieve some form of urinary control. However, the experience of most workers in this country is that the majority will be incontinent.In a review of 415 cases born in the years 1958-65 we found a continence rate of only 13% (Cooper, 1967), and in a more recent review of a further 112 cases we found this to be only 11 %.We have examined in greater detail a group of 142 children with myelomeningocele, of varying ages from 10 days to 13 years, with a view to establishing the state of continence, the results of intensive toilet training, and the future prognosis for these children under the age of 2 years at the time of the examination. The only method of studying bladder action in these children is by means of cystometric techniques. Cystometry has grown from a study of detrusor contraction to an elaborate physiological study of bladder function by the inclusion of uroflometry, pelvic floor studies, intra-abdominal

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“…For the first few years of life lack of bladder control is acceptable and life with nappies is expected (Smith, 1965;Nash, 1957;Carlson, 1966).…”

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confidence: 99%

“…Regular timed bladder expression is generally recommended to avoid stagnation (Williams, 1956;Nash, 1957;Smith, 1965;Carlson, 1966), and some workers (e.g. Williams, 1960;Carlson, 1966) have been prepared to continue with this regimen until the age of 8 or 9 years or even older in the hope of achieving reasonable bladder control.…”

mentioning

confidence: 99%