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Vasdev R, Softness K, Cahill D, Panagides J, Logvinenko T, Saunders R, Bauer S, Estrada C, Wang HHS. Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals. J Pediatr Urol 2024; 20:482.e1-482.e6. [PMID: 38402080 DOI: 10.1016/j.jpurol.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale. OBJECTIVE We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals. STUDY DESIGN We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD-10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty. RESULTS In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p < 0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p < 0.001, Figure 1). Sensitivity analysis using only first intra-detrusor Botox injection per patient demonstrated similarly significant increasing trend. DISCUSSION Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly. CONCLUSIONS Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.
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Affiliation(s)
- Ranveer Vasdev
- Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN, USA.
| | - Kenneth Softness
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, Boston, MA, USA.
| | - Dylan Cahill
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA.
| | - John Panagides
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA.
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Rachel Saunders
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA
| | - Carlos Estrada
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Hsin-Hsiao Scott Wang
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Altan M, Bozacı AC, Asci A, Dogan HS, Tekgul S. Autoaugmentation: A Feasible Option before Ileal Augmentation in Selected Cases. Eur J Pediatr Surg 2022; 32:370-375. [PMID: 34823263 DOI: 10.1055/s-0041-1739419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of autoaugmentation (AA) in pediatric population. MATERIALS AND METHODS The data of 59 patients (32 females and 27 males) who underwent AA between 1993 and 2018 were analyzed retrospectively. During postoperative follow-up, deterioration on renal scan and/or nonimproved hydronephrosis (HN) were described as upper urinary tract (UUT) impairment. Incontinence was described as use of diaper or pad. Preoperative urodynamic volume was divided into two as less than 50 and more than or equal to 50% expected bladder capacity (EBC). The effect of preoperative clinical factors on reaugmentation, incontinence, and UUT impairment was evaluated. RESULTS The mean age and the median follow-up were 8.9 ± 3.6 years and 64 (12-218) months, respectively. Ten (16.9%) patients underwent reaugmentation (ureteral or ileal). UUT impairment and incontinence rates were 13.6% (8/59) and 30.5% (18/59), respectively. On multivariate analysis, less than 50% EBC was the only predictor of reaugmentation and incontinence (p = 0.013, odds ratio [OR]: 17.546 and p = 0.035, OR: 3.750, respectively). Preoperative HN was predictor of UUT impairment (p = 0.041, OR: 10.168). After AA, 51 patients used clean intermittent catheter and 27 (45.8%) patients discontinued the use of anticholinergic medication. At follow-up, eight (13.5%) patients underwent surgery after AA due to long-term complications, dissatisfaction, or poor functional results (bladder neck injection, cystolithotripsy, Mitrofanoff revision, dilatation, and injection). CONCLUSION AA is a viable option in selected cases with high pressure and low compliant bladders. Preoperative bladder capacity is significant for reaugmentation rate and continence. UUT impairment is related to preoperative HN.
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Affiliation(s)
- Mesut Altan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Cansu Bozacı
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Sbizzera M, Descotes F, Arber T, Neuville P, Ruffion A. Bladder cancer detection in patients with neurogenic bladder: are cystoscopy and cytology effective, and are biomarkers pertinent as future diagnostic tools? A scoping review. World J Urol 2022; 40:1897-1913. [PMID: 35119523 DOI: 10.1007/s00345-022-03943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To summarize the current state of knowledge on bladder cancer diagnosis and screening in neurogenic bladder patients, and to explore the potential contribution of biomarkers in this context. METHODS A scoping review was performed to retrieve cystoscopy and urinary cytology performance for bladder cancer detection in neurogenic bladder patients. We also retrieved information of certified urinary biomarkers in bladder cancer detection and their potential application for this specific population. RESULTS A total of 1092 articles were identified; 19 of them were included in the scoping review regarding cytology and cystoscopy performance in patients with neurogenic bladder and 33 were included as related to biomarkers in bladder cancer. No significant study stood out to recommend bladder cancer screening in this specific population using cytology and cystoscopy because of the scarcity of results, low level-of-evidence studies, and lack of studies specifically designed to assess the test performance in this population. Two biomarkers were retained as potential future diagnostic tools: FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection. CONCLUSION There is no sufficient quality data to support cystoscopy and urinary cytology as effective tools for the diagnostic and surveillance of bladder cancer in neurogenic bladder patients. FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection, stand out as candidates of interest for bladder cancer detection in this specific population and should be prospectively tested.
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Affiliation(s)
- Marc Sbizzera
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France.
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Françoise Descotes
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
| | - Théo Arber
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
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Mühlbauer J, Klotz D, Büttner S, Stein R, Younsi N. Bladder cancer in patients with neurogenic bladder disorder: a comparative study of different etiologies. World J Urol 2022; 40:1929-1937. [PMID: 35034168 DOI: 10.1007/s00345-021-03922-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The objective of this study was to conduct a comparative study of different etiologies of neurogenic bladder disorders (NBDs) in patients with bladder cancer (BC) regarding patient- and tumor-related parameters and their oncological outcome. METHODS Out of 98 patients with bladder tumors and neurogenic disease, 23 patients with BC and NBDs from Jan 1, 2010, to Dec 31, 2020, were included. The different etiologies of NBDs were merged in three groups based on the level of the nervous system (NS)-lesion: (i) central (n = 6), (ii) spinal cord (n = 10), and (iii) peripheral lesions (n = 7). RESULTS Patients with lesions at the spinal cord level were younger at the time of BC diagnosis compared to patients with central or peripheral NS lesions (54 vs. 68 vs. 78 years, p = 0.0219). However, the latency to malignant transformation was more than twice as long (33 vs. 15 years, p = 0.0108). Most tumors were muscle-invasive or locally advanced BCs (62%) and presented lymph node metastases (55%), resulting in a poor mean overall survival of 30.9 ± 3.6 months. No significant differences regarding histopathology, tumor stage, and oncological outcome could be observed between the groups. CONCLUSION Patients with NBDs have a poor prognosis regardless of their etiology or the level of NS lesion. Patients with spinal cord lesions, including congenital NBDs, appear to develop BC at a young age, but compared to other etiologies latency from NBD to BC is longer.
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Affiliation(s)
- Julia Mühlbauer
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - David Klotz
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sylvia Büttner
- Department for Biomathematics and Medical Statistics, Faculty of Medicine Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nina Younsi
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Kondo F, Matsumoto F, Suenaga S, Matsui F, Yazawa K, Nagahara A, Nishimura K, Ishizuya Y. Bladder Cancer in a Long-term Survivor of the Prune Belly Syndrome. Urology 2021; 161:93-95. [PMID: 34883158 DOI: 10.1016/j.urology.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
Abstract
Prune belly syndrome (PBS) is a rare but morbid complexity of congenital anomalies that consists of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. With the recent advances in perinatal care, the life expectancy of patients with PBS has improved. Although renal and sexual outcomes are frequently discussed in the literature, little is known about urinary tract malignancies in adulthood. Herein, we present a case of advanced bladder cancer in a 38-year-old man with PBS. To the best of our knowledge, a malignant tumor arising in a nondefunctionalized or nonaugmented bladder in patients with PBS has not been reported previously.
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Affiliation(s)
- Fuki Kondo
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Fumi Matsumoto
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan.
| | - Shinta Suenaga
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Futoshi Matsui
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Koji Yazawa
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yu Ishizuya
- Department of Urology, Higashiosaka City Medical Center, Osaka, Japan
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Bladder cancer in patients with spina bifida: a serious risk. World J Urol 2020; 39:1531-1537. [PMID: 32632554 DOI: 10.1007/s00345-020-03338-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE After bladder augmentation (BA) using bowel segments, it is known that there is a risk for secondary malignancies. It remains unclear whether this also applies to spina bifida (SB) patients without BA. The aim of this study was to analyze the frequency of bladder cancer (BC) in SB at a single tertiary institution and assess the patients' oncologic outcome. METHODS Patients with SB and BC treated from January 2016 until March 2020 were included and corresponding data were collected retrospectively. Endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Among 132 adult patients with SB, four with a median age of 34.5 years (IQR 31.5-36.8, range 31-37) had a BC. None of the patients had undergone BA. Most common symptoms included recurrent urinary tract infections (UTI) (75%) and hydronephrosis (75%). At the time of the diagnosis, tumors were locally advanced (≥ T3) and lymph-node positive in all cases. All patients underwent radical cystectomy with adjuvant chemotherapy in two out of four cases. Histology showed squamous cell carcinomas (SCC) or at least a squamous cell component in all patients. The median PFS was 5.9 months (IQR 5.1-124.5) and the median OS was 8.7 months (IQR 6.3-125.5). CONCLUSIONS SCC in SB can appear at a young age and is usually diagnosed in an advanced tumor stage with poor prognosis despite radical surgical resection. Patients with SB without BA with clinical symptoms, new onset of hematuria, and/or upper tract dilatation should receive a cystoscopy ± further imaging.
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Nettey OS, Bowen DK, Santiago-Lastra Y, Metcalfe P, Kielb SJ. Complications in adulthood for patients with paediatric genitourinary reconstruction. World J Urol 2020; 39:1029-1036. [PMID: 32529452 DOI: 10.1007/s00345-020-03295-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 06/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caring for adults with prior paediatric genitourinary reconstruction remains a challenge for adult providers. Reconstructions typically have occurred decades before; surgical records are not always available and patients and families may be unable to convey procedures performed. Spina bifida (SB) patients are vulnerable to cognitive decline which may compound these challenges. Changes in patient body habitus and loss of function may contribute to problems with previous reconstructions. METHODS This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on the evaluation and management of complications arising from genitourinary reconstruction in congenital neurogenic bladder patients. RESULTS Common complications experienced by congenital neurogenic bladder patients include recurrent urinary tract infection, incontinence of catheterizable channel and urinary reservoir as well as malignancy as this population ages. Preservation of renal function and prevention of urinary tract infection while optimizing continence are essential guiding principles in the care of these patients. Many of the recommendations, however, are gleaned from available data in the adult spinal cord patient (a more commonly studied population) or the paediatric urologic literature due to limited studies in adult management of such patients. CONCLUSION Close follow-up and vigilance is warranted to monitor for infectious, mechanical and malignant complications while optimizing preservation of the upper urinary tracts and patient quality of life.
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Affiliation(s)
- Oluwarotimi S Nettey
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Arkes 23rd floor, Chicago, IL, 60611, USA.
| | - Diana K Bowen
- Department of Adult and Pediatric Urology, Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Yahir Santiago-Lastra
- Department of Urology, University of Southern California San Diego, San Diego, CA, USA
| | - Peter Metcalfe
- Department of Surgery, Division of Pediatric Surgery, University of Alberta, Alberta, Canada
| | - Stephanie J Kielb
- Department of Urology, Gynecology, and Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management. Neurourol Urodyn 2019; 39:498-506. [PMID: 31794087 DOI: 10.1002/nau.24248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/16/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimes-even in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. MATERIAL & METHODS After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. CONCLUSION In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, First Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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10
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Kardos DJ, Kereskai L, Tornoczky T, Farkas K, Davidovics A, Farkas A, Vastyan AM, Pinter AB, Vajda P. Re-evaluation of histological findings after colocystoplasty and gastrocystoplasty. J Pediatr Urol 2019; 15:651.e1-651.e8. [PMID: 31735521 DOI: 10.1016/j.jpurol.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The potential of malignant transformation and its risk factors after bladder augmentation performed in childhood are still unknown. The necessity of surveillance cystoscopies and biopsies has been questioned in the past decade. OBJECTIVE In a previous study, the authors did not detect any malignancy after colocystoplasty (CCP) or gastrocystoplasty (GCP) during the short-term follow-up, however, various alterations of the mucosa were found. A correlation between the nature of histological changes and the frequency of bacterial colonization after CCP were also found. The authors hypothesized that a longer-term follow-up of their patients would reveal an increase in pathological change or show stronger association between the histological alteration, bacterial colonization, and/or stone formation. PATIENTS AND METHODS Thirty-five patients (20 cases of colocystoplasties - CCPs; 15 cases of gastrocystoplasties - GCPs) participated in the study published in 2002. All patients were followed biannually with endoscopic assessment and biopsies. Two independent pathologists, evaluated regular biopsies from the native bladder, from the segment used for augmentation and from the anastomosis line. Etiology, frequency of positive urine cultures, and stone events were recorded and compared with histological findings between groups and with the previously published results. RESULTS Continuous surveillance allowed the follow-up of 30 patients (CCP 19/20, GCP 11/15) for 20 and 15 years. No malignancies were identified. Results of biopsies showed significant difference between groups (summarized in the tables). Chronic inflammatory changes were found following both types of augmentations, but they were more common in the urothelium following GCP and more common in the colonic mucosa following CCP. The rate of metaplastic lesions was higher after gastrocystoplasty (GCP). Significant association was found between the etiologic factor and the nature of histological change after CCP, as metaplastic lesions occurred only in patients with bladder exstrophy. Stones occurred more frequently in exstrophy patients as well. The nature of the histological changes did not correlate with positive urine cultures in either of the groups. Significantly higher incidence of bacterial colonization and stone occurrence were found after CCP. CONCLUSIONS Long-term follow-up of the patients failed to reveal an increase in pathological changes, and no malignancies were observed. According to the results of this study, etiology of bladder dysfunction and the type of augmentation might influence the histological alterations after augmentation cystoplasty. The efficiency of surveillance cystoscopies and biopsies are low. The present data suggest that surveillance cystoscopy and biopsy should not be routinely performed, and should be done only if the symptoms are suspicious for malignancy.
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Affiliation(s)
- Daniel J Kardos
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Laszlo Kereskai
- Department of Pathology, University of Pecs, Medical School, Hungary
| | - Tamas Tornoczky
- Department of Pathology, University of Pecs, Medical School, Hungary
| | - Kornelia Farkas
- Institute of Bioanalysis, University of Pecs, Medical School, Hungary
| | - Anna Davidovics
- Department of Languages for Specific Purposes, University of Pecs, Medical School, Hungary
| | - Andrew Farkas
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Attila M Vastyan
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Andrew B Pinter
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Peter Vajda
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
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11
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Budzyn J, Trinh H, Raffee S, Atiemo H. Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation. Curr Urol Rep 2019; 20:50. [PMID: 31342172 DOI: 10.1007/s11934-019-0919-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance. RECENT FINDINGS Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data. It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.
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Affiliation(s)
- Jeffrey Budzyn
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Hamilton Trinh
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Samantha Raffee
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Humphrey Atiemo
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA.
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12
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Self D, Ranasinghe W, Edirisinghe A, Ruthven S. Primary squamous cell carcinoma of the bladder presenting with colovesical and vesicocutaneous fistulae in a 29-year-old. ANZ J Surg 2019; 90:E34-E37. [PMID: 31033176 DOI: 10.1111/ans.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Duncan Self
- Gosford Hospital, Gosford, New South Wales, Australia
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13
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Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center. Int Neurourol J 2019; 22:287-294. [PMID: 30599500 PMCID: PMC6312970 DOI: 10.5213/inj.1836174.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/18/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. METHODS A retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. RESULTS Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. CONCLUSION We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.
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14
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Kapoor R, De Carlo K, Raman L, Thibadeau J, Kancherla V. Needs assessment survey for children and adults with spina bifida in Georgia. J Pediatr Rehabil Med 2019; 12:383-392. [PMID: 31744034 DOI: 10.3233/prm-190567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE We conducted a needs assessment among parents/guardians of children and independent adults with spina bifida, served by the Spina Bifida Association of Georgia (SBAGA). The objective was to assess if SBAGA is adequately meeting the needs of its constituents and to identify challenges and opportunities to improve services. METHODS The survey targeted all members of SBAGA in 2017. Survey questions were drafted separately for parents/guardians of children, and independent adults with spina bifida. Both closed- and open-ended response options were provided. The survey was pilot-tested, and administered in English and Spanish, using email, post, or in person. RESULTS A total of 119 individuals completed the survey. For parents/guardians (n= 96), the most important needs were bladder and bowel education, social and communication skills education, medical support, and transition and independence training. Independent adults (n= 23) responded that they mostly needed bladder and bowel education, medical support, and transition and independence training. Location of the SBAGA events and transportation to the events were the most frequent limiting factors for both groups. CONCLUSIONS Our survey findings highlighted that SBAGA services are valued overall. The survey findings will be used to guide quality improvement of current programs, and develop programs addressing emerging needs and challenges.
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Affiliation(s)
- Renuka Kapoor
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Lisa Raman
- Spina Bifida Association of Georgia, Atlanta, GA, USA
| | | | - Vijaya Kancherla
- Spina Bifida Association of Georgia, Atlanta, GA, USA.,Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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15
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Mukherjee S, Pasulka J. Care for Adults with Spina Bifida: Current State and Future Directions. Top Spinal Cord Inj Rehabil 2018; 23:155-167. [PMID: 29339892 DOI: 10.1310/sci2302-155] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The care for adults with spina bifida is an important area to study. As increasing numbers of patients with spina bifida survive into adulthood, they expect to thrive and receive the best possible care into adulthood to maintain their health. Understanding the health needs in this emerging and changing population will help clinicians provide the best anticipatory care for adults with spina bifida and continue to improve outcomes. This will also impact pediatric care by improving the ability to determine preventive methods from early on and understand the impacts of pediatric care and decisions over the lifespan.
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Affiliation(s)
- Shubhra Mukherjee
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, Illinois
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16
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Bladder cancer in patients with spina bifida: observation from an adult clinic. Spinal Cord Ser Cases 2018. [DOI: 10.1038/s41394-018-0066-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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17
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Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 2018; 50:1005-1016. [PMID: 29569211 DOI: 10.1007/s11255-018-1852-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. METHODS Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). RESULTS Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. CONCLUSION Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
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18
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Skokan AJ, Kovell RC. Advances and Challenges in Transitional Urology: Caring for Adolescents and Young Adults with Lifelong Complex Genitourinary Conditions. Curr Urol Rep 2018. [PMID: 29516272 DOI: 10.1007/s11934-018-0774-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW As long-term survival with complex congenital and pediatric diseases has improved, more patients with congenital genitourinary conditions are living into adulthood. These patients can continue to face lifelong issues related to their conditions, including urinary incontinence, recurrent urinary tract infections, chronic kidney disease, and difficulties with sexual health and function. RECENT FINDINGS The practice of transitional urology continues to grow nationwide and abroad, and it will be important to develop evidence-based practices for coordinated transition of these patients into the adult health care setting. This review describes the broader attention to transitions of care in medicine and specifically evaluates spina bifida as a model disease system for implementation of transitional practices in urology.
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Affiliation(s)
- Alexander J Skokan
- Division of Urology, University of Pennsylvania Health System, 3400 Civic Center Blvd, 3rd Floor - West Pavilion, Philadelphia, PA, 19104, USA
| | - Robert Caleb Kovell
- Division of Urology, University of Pennsylvania Health System, 3400 Civic Center Blvd, 3rd Floor - West Pavilion, Philadelphia, PA, 19104, USA. .,University of Pennsylvania Health System and the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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19
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Islam MM, Saltzman AF, Carrasco A, Higuchi T. Incidental Discovery of Adenocarcinoma of an Augmented Bladder in a Patient With Myelomenigocele Undergoing Cystolithotomy. Urology 2017; 113:203-205. [PMID: 29196068 DOI: 10.1016/j.urology.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Abstract
Bladder malignancy in patients with congenital bladder anomalies who have undergone bladder augmentation is a rare but well-recognized condition. These patients present with locally advanced or metastatic disease and have poor survival. We report a case of a patient with myelomeningocele who was incidentally found to have a high-grade intestinal type adenocarcinoma of her bladder augment at the time of cystolithotomy. This case highlights the need to continue to follow patients with congenital bladder anomalies and highlights the lack of adequate screening methods available.
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Affiliation(s)
- Majdee M Islam
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
| | - Amanda F Saltzman
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO.
| | - Alonso Carrasco
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
| | - Ty Higuchi
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
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20
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Ali P, Lefevre C, Perrouin-Verbe B, Le Normand L, Rigaud J, Bouchot O, Levesque A, Perrouin-Verbe MA. [Bladder cancer in neurogenic patients: A retrospective study of management and follow-up]. Prog Urol 2017; 28:215-220. [PMID: 29174817 DOI: 10.1016/j.purol.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The prevalence of bladder cancer (BC) in neurological patients seems to be similar to that of the general population. However, they are more aggressive with a higher rate of muscle-invasive forms and squamous cells carcinomas. The aim of the current study was to report etiologies, management and outcomes of BC in neurological population. MATERIAL AND METHOD Were enrolled all neurological patients with a BC diagnosed between 2004 and 2017. The following data were retrospectively reported: age, gender, duration of the disease, mode of discovery, histological type, treatment and outcomes. RESULTS In total, 27 patients were included: 11 spinal cord injuries, 7 Parkinson's disease, 5 multiple sclerosis, 3 head trauma, 3 brain strokes, 2 cerebral palsies and 1 spina bifida. The histological subtypes were as follows: 22 transitional cells carcinomas, 4 squamous cell carcinomas (SCC), one mucinous adenocarcinoma, one sarcomatoid and one neuroendocrine with 19 high-grade tumors and 15 muscle-invasive bladder cancer. Seven patients (26%) were diagnosed before 15 years history of neurogenic bladder. The mean follow-up was 14 months (1-210 months). Eight deaths were observed, with 5 related to bladder cancer. In our study, smoking habits, voiding mode, lithiasis or infection histories were not related with a more aggressive pattern, such as SCC. CONCLUSION The high rate of muscle-invasive bladder cancer and aggressive patterns justify neuro-urological follow-up, even before 15 years of neurogenic bladder. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- P Ali
- Faculté de médecine d'Angers, 49100 Angers, France; Service de médecine physique et de réadaptation, CHU d'Angers, 49100 Angers, France
| | - C Lefevre
- Service de médecine physique et réadaptation neurologique, hôpital Saint-Jacques, CHU de Nantes, 44000 Nantes, France
| | - B Perrouin-Verbe
- Service de médecine physique et réadaptation neurologique, hôpital Saint-Jacques, CHU de Nantes, 44000 Nantes, France
| | - L Le Normand
- Clinique urologique, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - J Rigaud
- Clinique urologique, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - O Bouchot
- Clinique urologique, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - A Levesque
- Clinique urologique, CHU de Nantes, Hôtel Dieu, Nantes, France
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21
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Ismail S, Karsenty G, Chartier-Kastler E, Cussenot O, Compérat E, Rouprêt M, Phé V. Prevalence, management, and prognosis of bladder cancer in patients with neurogenic bladder: A systematic review. Neurourol Urodyn 2017; 37:1386-1395. [PMID: 29168217 DOI: 10.1002/nau.23457] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
AIM To perform a systematic review of the literature regarding epidemiology, diagnosis, management and prognosis of bladder cancer in the neuro-urological patient population, in order to serve as a basis for future recommendations and research. METHODS A systematic review was performed according to the PRISMA-Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Statement. Embase was searched for studies providing data on epidemiology, diagnosis, management and prognosis of bladder cancer in neuro-urological patients. RESULTS After screening 637 abstracts, 15 studies (13 retrospective and 2 prospective studies) were included in this study. We identified 332 patients (0.3%) who were diagnosed with bladder cancer. This mostly affected mostly men (59.3%) and spinal cord injured patients (98.8%). Mean age at diagnosis was 56.1 years. Bladder cancer occurred after a long period of evolution of the neurological disease (24.9 years). Gross hematuria was the predominating presenting symptom (31.6% of cases). Indwelling urethral or supra-pubic catheters were used in 44.5% of patients. The most frequent histological subtype of bladder cancer was transitional cell carcinoma (53.1%), followed by squamous cell carcinoma (33.5%). Muscle-invasive bladder cancer was reported in 67.7% of patients. The mean cancer-specific mortality rate was of 47.1%. CONCLUSIONS The prevalence and high mortality rate of bladder cancer in neuro-urological patients underlines the importance of long-term follow-up in this specific population. This highlights the necessity of further studies in this field.
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Affiliation(s)
- Salima Ismail
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Gilles Karsenty
- La Conception Hospital, Department of Urology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Eva Compérat
- Department of Pathology, Tenon Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
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22
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Systematic review of bladder cancer outcomes in patients with spina bifida. J Pediatr Urol 2017; 13:456.e1-456.e9. [PMID: 28687411 DOI: 10.1016/j.jpurol.2017.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with congenital bladder anomalies, bladder augmentation is used as a last resort to reduce intravesical pressure, but concerns about malignant transformation in augmented patients were first raised in the 1980s. The best evidence to date indicates that augmentation does not appear to increase the risk of bladder cancer in spina bifida patients. To date, oncologic outcomes from patients with spina bifida with and without augmentation have only been available in small case reports. OBJECTIVE To systematically evaluate factors in myelomeningocele patients with bladder cancer, including bladder augmentation, that contribute to overall survival (OS). STUDY DESIGN A systematic review using PubMed was conducted by cross referencing terms 'myelomeningocele,' 'cystoplasty,' 'bladder cancer' and respective synonyms according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were studies with patients with an underlying diagnosis of myelomeningocele and bladder cancer with data on age, stage, and mortality status. Studies were excluded for spinal cord injury, history of tuberculosis or schistosomiasis, or prior ureterosigmoidostomy. RESULTS Fifty-two patients were identified from 28 studies with a median age at bladder cancer diagnosis of 41 years (range 13-73); 37 (71%) presented with stage III or IV bladder cancer. Overall survival at 1 year and 2 years was 48.5% and 31.5%, respectively. Overall survival was different between those with and without augmentation (P = 0.009) by log-rank analysis. No between-group differences in OS were seen based on age, management with indwelling catheter, diversion with ileal conduit or being on a surveillance program. Only stage remained a significant predictor of OS on multivariate analysis (HR 2.011, 95% CI 1.063-3.804, P = 0.032). Secondary analysis was performed after removing patients with gastric augmentation (n = 8), and no difference in OS was seen between patients with (n = 8) and without augmentation (n = 36, P = 0.112). Of augmented patients, latency to development of bladder cancer was variable (Summary Figure). DISCUSSION Bladder cancer is a deadly diagnosis in patients with congenital bladder anomalies like spina bifida, and while overall prevalence of the two conditions occurring together is low, bladder cancer will go on to affect 2-4% of spina bifida patients. The present study examined overall survival, and further characterized outcomes in these patients. Presence of a bladder augment did not appear to worsen overall survival. CONCLUSIONS Patients with myelomeningocele who developed bladder cancer had aggressive disease. Augmentation did not worsen OS, based on cases reported in the literature. Risk of bladder cancer should be discussed with all myelomeningocele patients.
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23
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Hsieh MH, Wood HM, Dicianno BE, Dosa NP, Gomez-Lobo V, Mattoo TK, Misseri R, Norton JM, Sawin KJ, Scal P, Wright JE, Star RA, Bavendam T. Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Urology 2017; 103:261-271. [PMID: 28163084 DOI: 10.1016/j.urology.2016.12.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/02/2016] [Accepted: 12/03/2016] [Indexed: 12/20/2022]
Abstract
Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs.
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Affiliation(s)
- Michael H Hsieh
- Children's National Health System, George Washington University, Washington, DC
| | - Hadley M Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Brad E Dicianno
- University of Pittsburgh Medical Center, Department of Physical Medicine and Rehabilitation, Pittsburgh, PA
| | - Nienke P Dosa
- Center for Development Behavior and Genetics, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY
| | - Veronica Gomez-Lobo
- MedStar Washington Hospital Center/Children's National Medical Center, Georgetown University, Washington, DC
| | - Tej K Mattoo
- Wayne State University School of Medicine, Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Detroit, MI
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Jenna M Norton
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kathleen J Sawin
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee (UWM), Children's Hospital of Wisconsin (CHW), Milwaukee, WI
| | - Peter Scal
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - James E Wright
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, MD
| | - Robert A Star
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Tamara Bavendam
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Manley KV, Hubbard R, Swallow D, Finch W, Wood SJ, Biers SM. Risk factors for development of primary bladder squamous cell carcinoma. Ann R Coll Surg Engl 2017; 99:155-160. [PMID: 27869492 PMCID: PMC5392846 DOI: 10.1308/rcsann.2016.0343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the prevalence of risk factors for primary squamous cell carcinoma (SCC) of the bladder. MATERIALS A total of 90 cases of primary SCC of the bladder were identified through multicentre analysis. Patient demographics, stage and grade of cancer at presentation, management and outcomes were recorded. The presence of known risk factors (catheter use, neuropathic bladder, smoking history, recurrent urinary tract infection and bladder stones) was also documented. RESULTS Over half of the patients had at least one identifiable risk factor for the development of primary bladder SCC: 13.9% of patients had a history of catheter use (clean intermittent self-catheterisation [CISC] in 11.1%), 10.0% of patients had a neuropathic bladder, 27.8% were smokers or ex-smokers and 20.0% had a documented history of recurrent urinary tract infection. Statistical analysis of the results showed no association between risk factors and grade of tumour at presentation. CONCLUSIONS These data further support the association between primary bladder SCC and several of the well documented risk factors for its development. Chronic use of CISC may confer a greater risk for development of SCC than thought previously. Further evidence of the role of CISC in primary SCC is required to justify routine screening and to determine exactly when surveillance of the bladder should begin for this group of patients.
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Affiliation(s)
- K V Manley
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - R Hubbard
- Cambridge University Hospitals NHS Foundation Trust , Germany
| | - D Swallow
- Mid Essex Hospital Services NHS Trust , UK
| | - W Finch
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - S J Wood
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - S M Biers
- Cambridge University Hospitals NHS Foundation Trust , Germany
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Grapin-Dagorno C, Peycelon M, Philippe-Chomette P, Berrebi D, El Ghoneimi A, Orbach D. [Urothelial tumors in children]. Bull Cancer 2016; 104:195-201. [PMID: 28034440 DOI: 10.1016/j.bulcan.2016.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/26/2016] [Indexed: 11/29/2022]
Abstract
Urothelial tumors are very rare in children (to date, only about 150 cases have been reported worlwide). Only 20% occur before the age of ten. The aim of this study is to specify the clinicopathologic features of urothelial tumor in young patients, which require a slightly different approach to treatment. On the basis of the WHO/ISUP (World Health Organisation/International Society of Urological Pathology) consensus classification report, these lesions are usually low-grade lesions, non invasive, and rarely recurrent. The sex ratio is three boys to one girl. These tumors are located preferentially in the low urinary tract, especially in the bladder. The main symptom is the macroscopic hematuria, which requires ultrasound examination in all cases. Cystoscopy is indicated in case of lesion of the bladder wall, or in case of persistent or recurrent hematuria, to obtain definitive diagnosis and biopsies. The tumors are mainly located on the posterior or lateral bladder wall above the trigone or near the ureteral orifices. Treatment is based on the transurethral resection of the lesion. The subsequent monitoring is sparsely codified, due to the exceptional occurrence of these tumors in the paediatric age group. These patients are likely to have better outcome than older patients, but it is due to the predominance of noninvasive papillary urothelial tumors. Tumor recurrences are not uncommon. In case of invasive, high-grade urothelial carcinomas, metastases or even lethal outcome may occur in rare cases.
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Affiliation(s)
- Christine Grapin-Dagorno
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France.
| | - Matthieu Peycelon
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascale Philippe-Chomette
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Dominique Berrebi
- Hôpital Robert-Debré, service d'anatomopathologie, 48, boulevard Sérurier, 75019 Paris, France
| | - Alaa El Ghoneimi
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Daniel Orbach
- Institut Curie, service d'oncopédiatrie, 26, rue d'Ulm, 75005 Paris, France
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26
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Boissier R, Di Crocco E, Faure A, Hery G, Delaporte V, Lechevallier E, Mouriquand PDE, Guys JM, Karsenty G. What is the outcome of paediatric gastrocystoplasty when the patients reach adulthood? BJU Int 2016; 118:980-986. [PMID: 27322857 DOI: 10.1111/bju.13558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To document the long-term outcomes of paediatric augmentation gastrocystoplasty (AGC) in terms of preservation of renal function and maintenance of dryness, and to analyse the rate of complications. PATIENTS AND METHODS The medical records of children who had undergone AGC between 1992 and 2000 (minimum time interval of 15 years) were reviewed retrospectively. The following data were collected: age at surgery, the cause of bladder dysfunction, functioning of the AGC, any complications, and the long-term outcome of the patients. All of the patients were re-contacted by telephone. RESULTS A total of 11 AGCs were carried out between 1992 and 2000, at a median (range) age of 11 (6.5-14) years. The diagnosis of patients undergoing AGC included myelomeningocele (four), bladder exstrophy (four), posterior urethral valves (one), irradiated bladder (one), and Prune Belly syndrome (one). The median [interquartile range (IQR)] follow-up was 17 (15-19.5) years. Renal function was preserved or improved in seven of the 11 patients and nine patients were dry after AGC. Seven of the 11 patients reported symptoms linked to haematuria-dysuria syndrome, which was resistant to treatment in one case and requiring excision of the gastric patch. Three of the 11 patients developed a tumour on the gastric graft after a median (range) delay of 20 (11-22) years after the initial procedure. All had gastric adenocarcinoma of which two were metastatic at the time of diagnosis requiring pelvectomy with pelvic lymph node dissection and adjuvant chemotherapy. Seven of the 11 patients underwent excision of the gastric patch after a median (IQR) time of 11 (8.5-20.5) years. CONCLUSIONS Our long-term data confirmed that most patients undergoing AGC had preservation of their renal function and were continent. However, long-term, AGC was associated with a significant risk of malignant transformation and a high rate of surgical re-intervention involving removal of the gastric patch. These results question the use of this technique for bladder augmentation, irrespective of the indication. We highlight the importance of strict endoscopic follow-up of all patients already having undergone an AGC and the need to inform and educated patients about tumour-related symptoms.
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Affiliation(s)
- Romain Boissier
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Eugenie Di Crocco
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Geraldine Hery
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Véronique Delaporte
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Pierre D E Mouriquand
- Service d'Urologie Pédiatrique, Hospices Civils de Lyon et Université Claude Bernard, Lyon 1, CHU Hôpital, Femme Mère Enfant, Bron, France
| | - Jean-Michel Guys
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
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Wang L, Zhou Z, Gong MZ, Pan DL, Zhang XH, Li NC, Na YQ. A Large Bladder Tumor Covered With a Thick "Shell" of Necrotic Material: Misdiagnosis of a Patient With Spina Bifida. Medicine (Baltimore) 2016; 95:e3443. [PMID: 27100442 PMCID: PMC4845846 DOI: 10.1097/md.0000000000003443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bladder tumor arising in a spina bifida patient is rare and may be clinically latent. We report the case of a 61-year-old female patient with spina bifida, neurogenic bladder, and a history of recurrent urinary tract infections. A B-ultrasound and non-contrast computed tomography scan did not reveal any bladder mass, but an unexplained "well-filled" bladder was observed, which was confusing as the catheter was present and open. However, a subsequent cystoscopic evaluation revealed a large bladder mass measuring 9.5 × 9.0 × 6.5 cm³, which almost filled the entire bladder. The mass had coarse and flocculent surface and seemed to be free from each observed wall of the urinary bladder. It was diagnosed as an infectious necrotic mass based on its appearance. During transurethral resection of the mass, a bladder tumor was suspected as small blood vessels and bleeding appeared within the inner layer of the mass. Pathological examination revealed necrotic material, inflammatory cells, and urothelial carcinoma cells. Then, a radical cystectomy was performed, and the pathological results indicated stage pT3bN0M0 transitional cell carcinoma. In the gross specimen, the base of the tumor measured 3 × 3 cm² on the top of the back wall of the bladder. Bladder tumors may have atypical presentations in patients with spina bifida. Regular screening is helpful for earlier detection and improving outcomes of bladder tumors in such patients.
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Affiliation(s)
- Lei Wang
- From the Department of Urology, Peking University Shougang Hospital (LW, ZZ, D-LP, X-HZ, N-CL, Y-QN); Peking University Wu Jieping Urology Center (LW, ZZ, D-LP, X-HZ, N-CL, Y-QN); and Department of Pathology, Peking University Shougang Hospital, Peking University Health Science Center (MG), Beijing, China
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Abstract
The population of patients with congenital genitourinary disorders has unique healthcare demands that require an additional interpersonal and medical skillset. Adults with congenital neurogenic bladder may have complex urinary anatomy, abnormal bladder function and atypical voiding mechanisms. While initial surgery and care of these patients is typically managed by a pediatric urologist, growth and development into adulthood necessitates transition of care to an adult care team. Failure of transition to adult care has been demonstrated to result in lower quality healthcare and increased risk of developing preventable complications.
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Affiliation(s)
- Christopher J Loftus
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Hadley M Wood
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
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30
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Liu JS, Greiman A, Casey JT, Mukherjee S, Kielb SJ. A snapshot of the adult spina bifida patient - high incidence of urologic procedures. Cent European J Urol 2016; 69:72-7. [PMID: 27123330 PMCID: PMC4846714 DOI: 10.5173/ceju.2016.596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/19/2015] [Accepted: 11/29/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction To describe the urologic outcomes of contemporary adult spina bifida patients managed in a multidisciplinary clinic. Material and methods A retrospective chart review of patients seen in our adult spina bifida clinic from January 2004 to November 2011 was performed to identify urologic management, urologic surgeries, and co-morbidities. Results 225 patients were identified (57.8% female, 42.2% male). Current median age was 30 years (IQR 27, 36) with a median age at first visit of 25 years (IQR 22, 30). The majority (70.7%) utilized clean intermittent catheterization, and 111 patients (49.3%) were prescribed anticholinergic medications. 65.8% had urodynamics performed at least once, and 56% obtained appropriate upper tract imaging at least every other year while under our care. 101 patients (44.9%) underwent at least one urologic surgical procedure during their lifetime, with a total of 191 procedures being performed, of which stone procedures (n = 51, 26.7%) were the most common. Other common procedures included continence procedures (n = 35, 18.3%) and augmentation cystoplasty (n = 29, 15.2%). Only 3.6% had a documented diagnosis of chronic kidney disease and 0.9% with end-stage renal disease. Conclusions Most adult spina bifida patient continue on anticholinergic medications and clean intermittent catheterization. A large percentage of patients required urologic procedures in adulthood. Patients should be encouraged to utilize conservative and effective bladder management strategies to reduce their risk of renal compromise.
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Affiliation(s)
- Joceline S Liu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alyssa Greiman
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jessica T Casey
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shubhra Mukherjee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Snow-Lisy DC, Diaz EC, Bury MI, Fuller NJ, Hannick JH, Ahmad N, Sharma AK. The Role of Genetically Modified Mesenchymal Stem Cells in Urinary Bladder Regeneration. PLoS One 2015; 10:e0138643. [PMID: 26398705 PMCID: PMC4580420 DOI: 10.1371/journal.pone.0138643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/03/2015] [Indexed: 01/01/2023] Open
Abstract
Recent studies have demonstrated that mesenchymal stem cells (MSCs) combined with CD34+ hematopoietic/stem progenitor cells (HSPCs) can function as surrogate urinary bladder cells to synergistically promote multi-faceted bladder tissue regeneration. However, the molecular pathways governing these events are unknown. The pleiotropic effects of Wnt5a and Cyr61 are known to affect aspects of hematopoiesis, angiogenesis, and muscle and nerve regeneration. Within this study, the effects of Cyr61 and Wnt5a on bladder tissue regeneration were evaluated by grafting scaffolds containing modified human bone marrow derived MSCs. These cell lines were engineered to independently over-express Wnt5a or Cyr61, or to exhibit reduced expression of Cyr61 within the context of a nude rat bladder augmentation model. At 4 weeks post-surgery, data demonstrated increased vessel number (~250 vs ~109 vessels/mm2) and bladder smooth muscle content (~42% vs ~36%) in Cyr61OX (over-expressing) vs Cyr61KD (knock-down) groups. Muscle content decreased to ~25% at 10 weeks in Cyr61KD groups. Wnt5aOX resulted in high numbers of vessels and muscle content (~206 vessels/mm2 and ~51%, respectively) at 4 weeks. Over-expressing cell constructs resulted in peripheral nerve regeneration while Cyr61KD animals were devoid of peripheral nerve regeneration at 4 weeks. At 10 weeks post-grafting, peripheral nerve regeneration was at a minimal level for both Cyr61OX and Wnt5aOX cell lines. Blood vessel and bladder functionality were evident at both time-points in all animals. Results from this study indicate that MSC-based Cyr61OX and Wnt5aOX cell lines play pivotal roles with regards to increasing the levels of functional vasculature, influencing muscle regeneration, and the regeneration of peripheral nerves in a model of bladder augmentation. Wnt5aOX constructs closely approximated the outcomes previously observed with the co-transplantation of MSCs with CD34+ HSPCs and may be specifically targeted as an alternate means to achieve functional bladder regeneration.
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Affiliation(s)
- Devon C. Snow-Lisy
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
| | - Edward C. Diaz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
| | - Matthew I. Bury
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
| | - Natalie J. Fuller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
| | - Jessica H. Hannick
- Department of Urology, Loyola University Health System, Maywood, IL, United States of America
| | - Nida Ahmad
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
| | - Arun K. Sharma
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL, United States of America
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, United States of America
- Northwestern University, Simpson Querrey Institute for BioNanotechnology, Chicago, IL, United States of America
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States of America
- * E-mail:
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34
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Loftus C, Wood H. Emerging Concepts in Transitional Care of Congenital Genitourinary Reconstructions. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Snow-Lisy DC, Yerkes EB, Cheng EY. Update on Urological Management of Spina Bifida from Prenatal Diagnosis to Adulthood. J Urol 2015; 194:288-96. [DOI: 10.1016/j.juro.2015.03.107] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Devon C. Snow-Lisy
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth B. Yerkes
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Earl Y. Cheng
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Veenboer PW, de Kort LMO, Chrzan RJ, de Jong TPVM. Urinary considerations for adult patients with spinal dysraphism. Nat Rev Urol 2015; 12:331-9. [DOI: 10.1038/nrurol.2015.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Long-Term Outcomes Following Bladder Augmentation in Children with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0268-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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38
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Avallone MA, Prince MK, Guralnick ML, O’Connor RC. Long-Term Enterocystoplasty Follow-Up: Metabolic and Neoplastic Concerns. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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40
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D'souza N, Morton G, Chung HT. Radiation treatment of bladder squamous cell carcinoma in a patient with spina bifida: A case report. Can Urol Assoc J 2012; 6:E125-8. [PMID: 22709884 DOI: 10.5489/cuaj.11057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bladder cancer is the sixth most common cancer in Canada. While most patients present with transitional cell carcinoma, few present with squamous cell carcinoma (SCC). Risk factors for SCC include a history of chronic urinary tract infection, urothelial inflammation and indwelling catheters. We present the management of a patient with locally advanced SCC of the bladder.
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Affiliation(s)
- Neil D'souza
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON
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Ghousheh AI, Durkee CT, Groth TW. Advanced transitional cell carcinoma of the bladder in a 16-year-old girl with Hinman syndrome. Urology 2012; 80:1141-3. [PMID: 22743257 DOI: 10.1016/j.urology.2012.04.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/24/2012] [Accepted: 04/30/2012] [Indexed: 11/19/2022]
Abstract
The present report describes a 16-year-old girl with a history of Hinman syndrome who was found to have invasive transitional cell carcinoma of the bladder. Bladder cancer is rare in children. Typically, the tumors are of low grade and stage. We present the first case of a teenage girl diagnosed with Hinman syndrome who developed an invasive bladder transitional cell carcinoma. The patient with a neurogenic bladder who has undergone bladder augmentation is at increased risk for bladder cancer. This risk may now have to be extended out to the non-neurogenic neurogenic bladder population if further cases are identified.
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Affiliation(s)
- Anas I Ghousheh
- Department of Pediatric Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Stein R, Schröder A, Thüroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: non-surgical considerations. J Pediatr Urol 2012; 8:145-52. [PMID: 21493159 DOI: 10.1016/j.jpurol.2011.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 03/10/2011] [Indexed: 12/01/2022]
Abstract
Segments from almost all parts of the bowel have been used for urinary diversion. As a result, the available absorptive surface area of the bowel is reduced, and the incorporation of bowel segments into the urinary tract may have metabolic consequences. This is an area somewhat neglected in the literature. Metabolic complications are rare, but sub-clinical metabolic disturbances are quite common. Several studies have demonstrated that some of the absorbent and secreting properties of the bowel tissue are preserved after incorporation into the urinary tract. Hyperchloraemic metabolic acidosis can occur if ileal and/or colon segments are used, as well as malabsorption of vitamin B(12) and bile acid after the use of ileal segments. These metabolic effects are not as severe as may be suspected and can be prevented by prophylactic substitution. Secondary malignancies can develop as a long-term consequence of bladder augmentation. Using colonic segments, tumours are most likely to occur at the ureteral implantation site. To prevent metabolic complications, careful patient selection and meticulous and lifelong follow up, as well as prophylactic treatment, are mandatory. Endoscopy for early detection has been recommended, starting 10 years postoperatively for patients who underwent surgery for a benign condition.
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Affiliation(s)
- Raimund Stein
- Division of Pediatric Urology, Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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de Kort L, Bower W, Swithinbank L, Marschall-Kehrel D, de Jong T, Bauer S. The management of adolescents with neurogenic urinary tract and bowel dysfunction. Neurourol Urodyn 2012; 31:1170-4. [DOI: 10.1002/nau.22206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 01/10/2012] [Indexed: 11/11/2022]
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Sharma AK, Bury MI, Marks AJ, Fuller NJ, Meisner JW, Tapaskar N, Halliday LC, Matoka DJ, Cheng EY. A nonhuman primate model for urinary bladder regeneration using autologous sources of bone marrow-derived mesenchymal stem cells. Stem Cells 2011; 29:241-50. [PMID: 21732482 DOI: 10.1002/stem.568] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Animal models that have been used to examine the regenerative capacity of cell-seeded scaffolds in a urinary bladder augmentation model have ultimately translated poorly in the clinical setting. This may be due to a number of factors including cell types used for regeneration and anatomical/physiological differences between lower primate species and their human counterparts. We postulated that mesenchymal stem cells (MSCs) could provide a cell source for partial bladder regeneration in a newly described nonhuman primate bladder (baboon) augmentation model. Cell-sorted CD105(+) /CD73(+) /CD34(-) /CD45(-) baboon MSCs transduced with green fluorescent protein (GFP) were seeded onto small intestinal submucosa (SIS) scaffolds. Baboons underwent an approximate 40%-50% cystectomy followed by augmentation cystoplasty with the aforementioned scaffolds or controls and finally enveloped with omentum. Bladders from sham, unseeded SIS, and MSC/SIS scaffolds were subjected to trichrome, H&E, and immunofluorescent staining 10 weeks postaugmentation. Immunofluorescence staining for muscle markers combined with an anti-GFP antibody revealed that >90% of the cells were GFP(+) /muscle marker(+) and >70% were GFP(+) /Ki-67(+) demonstrating grafted cells were present and actively proliferating within the grafted region. Trichrome staining of MSC/SIS-augmented bladders exhibited typical bladder architecture and quantitative morphometry analyses revealed an approximate 32% and 52% muscle to collagen ratio in unseeded versus seeded animals, respectively. H&E staining revealed a lack of infiltration of inflammatory cells in grafted animals and in corresponding kidneys and ureters. Simple cystometry indicated recovery between 28% and 40% of native bladder capacity. Data demonstrate MSC/SIS composites support regeneration of bladder tissue and validate this new bladder augmentation model.
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Affiliation(s)
- Arun K Sharma
- Division of Pediatric Urology; Children's Memorial Hospital of Chicago, Chicago, Illinois, USA.
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Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2011; 109:1280-93. [PMID: 22117733 DOI: 10.1111/j.1464-410x.2011.10650.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's known on the subject? And what does the study add? There is a wealth of evidence on the development, indications, outcomes and complications of augmentation cystoplasty (AC). Over the last decade, new evidence has been emerging to influence our clinical practice and application of this technique. AC is indicated as part of the treatment pathway for both neurogenic and idiopathic detrusor overactivity, usually where other interventions have failed or are inappropriate. The most commonly used technique remains augmentation with a detubularised patch of ileum (ileocystoplasty). Controversy persists over the role of routine surveillance following ileocystoplasty for the detection of subsequent bladder carcinoma; however the indication for surveillance after gastrocystoplasty is clearer due to a rising incidence of malignancy in this group. Despite a reduction in the overall numbers of AC operations being performed, it clearly still has a role to play, which we re-examine with contemporary studies from the last decade.
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Affiliation(s)
- Suzanne M Biers
- Department of Urology, Leicester General Hospital, Leicester, UK.
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Abstract
INTRODUCTION To review the incidence and risks of bladder cancer following gastrointestinal augmentations done for congenial anomalies in childhood. MATERIALS AND METHODS A literature search using PubMed and Ovid Medline search engines was performed. MeSH terms evaluated were; bladder augmentations, enterocystoplasty, gastrocystoplasty, spina bifida, spinal dysraphism, myelodysplasia, neural tube defects, posterior urethral valves and bladder exstrophy were cross referenced with the terms, bladder cancer and urinary bladder neoplasm. All patients who developed a bladder cancer following a bladder augmentation for a congenital anomaly were reviewed. RESULTS A total of 20 cases of bladder cancer following augmentations for congential anomalies, were identified, 9 arose following ileal cystoplasty, 3 following colocystolasty and 8 following gastrocystoplasty. The incidence of cancer developing per decade following surgery was 1.5% for ileal/colonic and 2.8% for gastric bladder augmentations. The majority of cancers developing within the augmented bladder are at advanced stages at the time of diagnosis (60%; 12/20 cases were ≥T3 at diagnosis). Several of the cases that developed occurred in patients exposed to known carcinogenic stimuli and/or arose in bladders with a known predisposition to carcinoma. CONCLUSION Patients augmented with ileal or colonic segment for a congenital bladder anomaly have a 7-8 fold and gastric augments a 14-15 fold increased risk for the development of bladder cancer over standard norms. Published data is however unable to determine if gastrointestinal bladder augmentation is an independent risk factor for cancer over the inherent risk of cancer arising from a congenitally abnormal bladder.
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Affiliation(s)
- Douglas A Husmann
- Department of Urology 7, Gonda, Mayo Clinic Rochester, MN 55905, USA
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Bladder carcinoma in a 31-year-old female spina bifida patient with an auto-augmented bladder. Int Urol Nephrol 2011; 44:1027-30. [PMID: 21870090 PMCID: PMC3401495 DOI: 10.1007/s11255-011-0046-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/03/2011] [Indexed: 10/27/2022]
Abstract
We present the case of a 31-year-old spina bifida patient presenting with a poorly differentiated T3N1M0 bladder carcinoma with sarcomatoid differentiation in an auto-augmented bladder. She underwent a radical cystectomy and a bilateral lymph node dissection. However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis. This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy. It shows that bladder cancer also occurs in patients who underwent detrusorectomy, despite the fact that the risk is supposedly lower than in patients who underwent enterocystoplasty. Moreover, tumour spread to adjacent organs could occur more rapidly in auto-augmented bladders because of the lack of muscle tissue. The latter could have serious implications on the prognosis of these patients.
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Padmanabhan P. Bladder Augmentation and the Risk of Carcinoma. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mehan R, Misseri R, Vanderbrink B, Rink RC, Beck SDW. Metastatic transitional cell carcinoma of the bladder arising in a patient with bladder autoaugmentation. J Pediatr Urol 2011; 7:137-9. [PMID: 20739224 DOI: 10.1016/j.jpurol.2010.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 07/20/2010] [Indexed: 01/20/2023]
Abstract
We report a case of a metastatic transitional cell carcinoma of the bladder in a 20-year-old patient who had previously undergone resection of posterior urethral valves, clean intermittent catheterization, bladder autoaugmentation, and later renal transplantation. To our knowledge, this is the first report of transitional cell carcinoma following bladder autoaugmentation. We also review the literature on bladder autoaugmentation and transitional cell carcinoma.
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Affiliation(s)
- Rahul Mehan
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Piatt JH. Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults. J Neurosurg Pediatr 2010; 6:515-25. [PMID: 21121724 DOI: 10.3171/2010.9.peds10266] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. METHODS A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. RESULTS Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. CONCLUSIONS Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.
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Affiliation(s)
- Joseph H Piatt
- Section of Neurosurgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
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