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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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Abdelhalim A, Hafez AT. Antenatal and postnatal management of posterior urethral valves: where do we stand? AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Posterior urethral valve (PUV) is the leading etiology of lower urinary tract obstruction (LUTO) in boys and is an important cause of end-stage renal disease (ESRD) in children. The aim of this article is to review the current status on antenatal intervention for PUV as well as postnatal medical and surgical management.
Main body
MEDLINE, EMBASE, Pubmed and Google Scholar search was conducted throughout December 2020 using the keywords: posterior urethral valves, congenital urinary obstruction, antenatal, valve bladder syndrome, medical, anticholinergics, alpha blocker, antibiotics, biofeedback, diversion, augmentation cystoplasty and renal transplantation. Only papers written in English were included. The relevant literature was summarized. Despite advances in antenatal intervention for fetal LUTO, it remains associated with considerable fetal and maternal morbidity. Patient selection criteria for antenatal intervention are greatly debated. Fetal intervention has resulted in improved perinatal survival in properly selected cases, with a questionable benefit to postnatal renal function. There is decent evidence supporting the use of anticholinergics in infants and young children following valve ablation, with less robust evidence advocating alpha blockers, overnight catheter drainage and biofeedback. The role of urinary diversion remains contentious. Optimizing bladder dynamics is crucial for successful renal transplantation outcomes.
Conclusion
While antenatal intervention has failed to improve renal function outcomes of PUV, patient-centered medical and sometimes surgical interventions can help delay the progression of chronic kidney disease. Lifelong monitoring and management of the associated bladder dysfunction is indispensable even after successful renal transplantation.
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quadackers JSLT, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment. Neurourol Urodyn 2019; 39:45-57. [PMID: 31724222 DOI: 10.1002/nau.24211] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University 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, 1st 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 S L T Quadackers
- 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
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Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida. Pediatr Nephrol 2019; 34:1277-1282. [PMID: 30826869 DOI: 10.1007/s00467-019-04222-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/06/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spina bifida (SB) patients are at increased risk for hydronephrosis, bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries. METHODS We retrospectively reviewed patients born with SB 2005-2009, presenting to our institution within 1 year of birth. Outcomes at 8-11 years old included final renal/bladder ultrasound (RBUS) results, clean intermittent catheterization (CIC) use, anticholinergic use, surgical interventions, and final renal function. We excluded those without follow-up past age 8 and/or no RBUS or fluoroscopic urodynamic images (FUI) within the first year of life. Imaging was independently reviewed by four pediatric urologists blinded to radiologists' interpretation and initial findings compared with final outcomes. RESULTS Of 98 children, 62 met inclusion criteria (48% male, 76% shunted). Median age at last follow-up was 9.6 years. Upon initial imaging, 74% had hydronephrosis (≥ SFU grade 1), decreasing to 5% at 10 years (p < 0.0001). Initially, 9% had ≥ SFU grade 3 hydronephrosis, decreasing to 2% (p = 0.13). CIC and anticholinergic use increased from 61% and 37% to 87% and 86%, respectively (p = 0.001 and p < 0.0001, respectively). With follow-up, 55% had surgical intervention and 23% had an augmentation. Of children with a serum creatinine/cystatin-C at 8-11 years old, one had confirmed chronic kidney disease (stage 2). CONCLUSIONS Despite initial high incidence of hydronephrosis, this was low grade and resolved in the first decade of life. Additionally, the 8-11-year incidence of kidney disease and upper tract changes was low due to aggressive medical management.
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Abstract
Neurogenic bladder (NB) is a nonspecific term that may describe conditions ranging from areflectic noncontractile bladder to detrusor overactivity. The most common cause of NB in children is the presence of dysraphic malformations. Urodynamic evaluations make it possible to describe bladder dysfunctions and to plan a therapeutic strategy for each patient. In a child with NB there are two major dangerous functional problems seen in urodynamic investigations: high intravesical pressure in the storage phase and high pressure during urination. The basic goals of urologic treatment for a child with NB are the protection of the urinary tract from complications and improvement of continence. Treatment for a child with NB is usually conservative, and focuses on achieving safe bladder pressures during storage with reliable emptying, via voiding or catheterization. The two most important forms of conservative treatment are clean intermittent catheterization and pharmacological treatment of functional disorders. Some drugs are used in the treatment of functional disorders in children with NB, but none of the drugs are officially approved for small children and babies.
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Affiliation(s)
- Paweł Kroll
- Neuro-urology Unit, Pediatric Surgery and Urology Clinic, Ul. Pamiątkowa 2/42, 61-512, Poznań, Poland.
- Poznan University of Medical Sciences, Poznań, Poland.
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Krebs J, Scheel-Sailer A, Oertli R, Pannek J. The effects of antimuscarinic treatment on the cognition of spinal cord injured individuals with neurogenic lower urinary tract dysfunction: a prospective controlled before-and-after study. Spinal Cord 2017; 56:22-27. [PMID: 28786411 DOI: 10.1038/sc.2017.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Prospective controlled before-and-after study. OBJECTIVES To investigate the effects of antimuscarinic treatment of neurogenic lower urinary tract dysfunction on the cognition of individuals with spinal cord injury (SCI) during the early post-acute phase. SETTING Single SCI rehabilitation center. METHODS Patients with acute traumatic SCI admitted for primary rehabilitation from 2011 to 2015 were screened for study enrollment. Study participants underwent baseline neuropsychological assessments prior to their first urodynamic evaluation (6-8 weeks after SCI). Individuals suffering from neurogenic detrusor overactivity received antimuscarinic treatment, and those not requiring antimuscarinic treatment constituted the control group. The neuropsychological follow-up assessment was carried out 3 months after the baseline assessment. The effects of group and time on the neuropsychological parameters were investigated. RESULTS The data of 29 individuals were evaluated (control group 19, antimuscarinic group 10). The group had a significant (P≤0.033) effect on immediate recall, attention ability and perseveration. In the control group, individuals performed significantly (P≤0.05) better in immediate recall both at baseline (percentile rank 40, 95% CI 21-86 versus 17, 95% CI 4-74) and follow-up (percentile rank 40, 95% CI 27-74 versus 16, 95% CI 2-74). The time had a significant (P≤0.04) effect on attention ability, processing speed, word fluency and visuospatial performance. The individuals in both groups performed better at the follow-up compared to the baseline assessment. CONCLUSION Even though, we did not observe cognitive deterioration in the investigated, cognitively intact SCI individuals during the first 3 treatment months, the concerns regarding deleterious effects of antimuscarinics on cognition remain.
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Affiliation(s)
- J Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - A Scheel-Sailer
- Rehabilitation and Quality Management, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - R Oertli
- Neurology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - J Pannek
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
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