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Bozbeyoğlu SG, Ersoy F, Canmemiş A, Khanmammadova N, Özel ŞK. Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction. J Pediatr Urol 2024; 20:243.e1-243.e9. [PMID: 38057255 DOI: 10.1016/j.jpurol.2023.11.015] [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: 06/15/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. OBJECTIVE To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. STUDY DESIGN In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. RESULTS The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45 ± 4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p = 0.049, r = -0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58 ± 0.68 mm in the NC group and 2.18 ± 1.35 mm in the LC group (p = 0.044). Left lateral wall thickness was 1.45 ± 0.44 mm in the NC group and 2.02 ± 1.4 mm in the LC group (p = 0.033). DISCUSSION Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. CONCLUSION Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.
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Affiliation(s)
- Sabriye Gülçin Bozbeyoğlu
- Istanbul Goztepe Prof. Dr. Suleymands Yalcin City Hospital, Department of Radiology, Eğitim Mah Fahrettin Kerim Gökay Caddesi Kadıköy, 34722, Istanbul, Turkey.
| | - Furkan Ersoy
- Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Pediatric Surgery, Eğitim Mah Fahrettin Kerim Gökay Caddesi Kadıköy, 34722, Istanbul, Turkey.
| | - Arzu Canmemiş
- Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Pediatric Urology, Eğitim Mah Fahrettin Kerim Gökay Caddesi Kadıköy, 34722, Istanbul, Turkey.
| | - Narmina Khanmammadova
- Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Medical School, Eğitim Mah Fahrettin Kerim Gökay Caddesi Kadıköy, 34722, Istanbul, Turkey.
| | - Şeyhmus Kerem Özel
- Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Pediatric Surgery, Eğitim Mah Fahrettin Kerim Gökay Caddesi Kadıköy, 34722, Istanbul, Turkey.
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Playfair M, Elliott S, Welk B. The assessment and management of voiding dysfunction in adults living with cerebral palsy. World J Urol 2023; 41:3317-3323. [PMID: 37710012 DOI: 10.1007/s00345-023-04603-9] [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: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE Improvements in life expectancy have resulted in an increasing number of adults with cerebral palsy, of which over a third will have neurogenic lower urinary tract dysfunction (NLUTD). This review explores urinary dysfunction in adults with cerebral palsy. METHODS Relevant literature on NLUTD in adults with cerebral palsy was identified using an unrestricted search of PubMed. RESULTS Urinary incontinence is the most common complaint, often accompanied by frequency and urgency. Special consideration should be given to women and in those with worse motor or cognitive dysfunction as they have been shown to have more severe urologic symptoms. NLUTD can have significant morbidity and impact quality of life. Hospital admission, urinary tract infections, and hydronephrosis are common urologic complications, with poor urinary function associated with decreased quality of life (QOL). Neurogenic detrusor overactivity is the most common urodynamic abnormality, with elevated detrusor leak point pressure and reduced bladder capacity. Detrusor sphincter dyssynergy is present in some patients and maybe secondary to generalized spasticity or incomplete upper motor neuron injury. Elevated bladder capacity is also present in a portion of patients, and becomes particularly relevant in adults as a result of increased spasticity of the urinary sphincter. Conservative management like functional toileting strategies, medications, and incontinence aids are successful in most patients. Medical management with anticholinergics is well described, and frequently the only intervention required, particularly in children. Intermittent clean catheterization has mixed results with this population, as its efficacy is limited by pelvic spasticity and patient factors. Surgical intervention, while often successful, should be restricted to select patients, as it is associated with significant morbidity in this population. CONCLUSION Management of NLUTD in adults with CP involves conservative management, medications, and in rare cases surgical intervention.
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Affiliation(s)
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Blayne Welk
- Department of Surgery, Western University, London, ON, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
- Division of Urology and Epidemiology and Biostatistics, Western University, St Joseph's Health Care, Room B4-667, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Ferreira RVB, Pinheiro HCG, de Oliveira Melo F, Gama GL, Monteiro LMC, Fontes JM, de Oliveira Cruz GN, de Araújo GF, Amorim MMR, Melo A. Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil. Trop Med Int Health 2022; 27:583-591. [PMID: 35441418 DOI: 10.1111/tmi.13754] [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] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. METHODS This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. RESULTS Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. CONCLUSIONS UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.
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Affiliation(s)
| | | | | | - Gabriela Lopes Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
| | | | | | | | | | | | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
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Cornwell LB, Ewing E, Algra J, Chiang GJ. Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy? J Pediatr Urol 2021; 17:527.e1-527.e7. [PMID: 34162517 DOI: 10.1016/j.jpurol.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. STUDY DESIGN All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. RESULTS 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13 h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. DISCUSSION Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. CONCLUSIONS Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
| | - Emily Ewing
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - Jeffrey Algra
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - George J Chiang
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
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Uwaezuoke SN, Aronu AE. Routine Screening and Treatment of Urinary Tract Infection May Be Justified in Children and Adolescents with Cerebral Palsy: A Systematic Review. IRANIAN JOURNAL OF PEDIATRICS 2020; 30. [DOI: 10.5812/ijp.104036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 09/15/2023]
Abstract
Context: Children and adolescents with cerebral palsy may present with lower urinary tract dysfunction which increases their risk for urinary tract infection (UTI). Whereas few studies reported low prevalence rates of UTI in these patients, several studies documented high prevalence rates. Thus, it appears there is no unanimity about the burden of UTI in affected children and adolescents to justify routine screening and treatment of the infection. This systematic review aims to determine the risk and pooled prevalence rate of UTI in children and adolescents with cerebral palsy. Evidence Acquisition: Using appropriate descriptors, we searched the PubMed and Google Scholar databases. Eligible papers were primary studies published in English language: reporting an association between cerebral palsy and UTI or UTI prevalence in children and adolescents with cerebral palsy and healthy comparators, with a clear definition of UTI and cerebral palsy. We assessed the quality of included studies with the Newcastle-Ottawa Scale (NOS) and resolved inter-rater discrepancies by consensus. We independently retrieved relevant data from these studies using a preconceived data-extraction form. We analyzed the aggregate data on UTI prevalence in these pediatric patients, using the log odds ratio (OR) at 95% confidence interval as the summary estimate. Results: Of the seven included studies, only two (28.6%) were case-control studies, while five (71.4%) were cross-sectional studies. There was no uniform definition of UTI in these studies. Prevalence rates varied widely from as low as 2.2% to as high as 56.7%. The mean UTI prevalence rate estimated for six of the included studies was 31.8%. The log OR at 95% CI computed for the case-control studies was 10.9 (95% CI: 9.0, 12.9). Conclusions: The prevalence and risk of UTI in children and adolescents with cerebral palsy are significantly high. Routine screening and treatment for UTI may be justified in these pediatric patients. We however recommend more prospective case-control studies to strengthen the current evidence of the high UTI burden in these patients.
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Ryakitimbo A, Philemon R, Mazuguni F, Msuya L. Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:59-65. [PMID: 29774893 PMCID: PMC5947104 DOI: 10.2147/phmt.s159766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Urinary tract infection (UTI) in children with cerebral palsy (CP) is a challenging yet common clinical condition. Children with CP bare the greatest risk of contracting UTI because of their difficulties in neuromotor control which lead to delay of bladder control, causing incomplete bladder emptying and urine retention. Method This was an analytical cross-sectional study that was conducted from September 2016 to March 2017 at Comprehensive Community Based Rehabilitation in Tanzania – Moshi and Kilimanjaro Christian Medical Centre Neurological Pediatrics Outpatient Clinic. All children who met the inclusion criteria were studied. Urine samples were collected at one point by catheterization, and urine dipstick and urine culture were done. Data were analyzed using SPSS version 20. Results A total of 99 children were enrolled in the study. The median age was 4 years (3–8 years); 53.5% were aged between 2 and 4 years. More than half were male. UTI was detected in 13.1% (n=13) of the children. Five causative agents of UTI were isolated, namely Escherichia coli, Proteus mirabilis, Klebsiella pneumonia, Staphylococcus aureus, and Enterococcus faecalis. The two most common organisms, E. coli and P. mirabilis, both had low sensitivity to ampicillin and co-trimoxazole while they were sensitive to ciprofloxacin and ceftriaxone. Conclusion UTI is a common finding among children with CP. E. coli and P. mirabilis are the commonest causative agents and are sensitive to ciprofloxacin and ceftriaxone but have low sensitivity to ampicillin and co-trimoxazole.
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Affiliation(s)
- Amon Ryakitimbo
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Festo Mazuguni
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Levina Msuya
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Samijn B, Van Laecke E, Renson C, Hoebeke P, Plasschaert F, Vande Walle J, Van den Broeck C. Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review. Neurourol Urodyn 2016; 36:541-549. [DOI: 10.1002/nau.22982] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Bieke Samijn
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
| | - Erik Van Laecke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | | | - Piet Hoebeke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Frank Plasschaert
- Department of Orthopaedic Surgery; Ghent University Hospital; Ghent Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology; Ghent University Hospital; Ghent Belgium
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Guerra L, Leonard M, Castagnetti M. Best practice in the assessment of bladder function in infants. Ther Adv Urol 2014; 6:148-64. [PMID: 25083164 PMCID: PMC4054507 DOI: 10.1177/1756287214528745] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this article is to review normal developmental bladder physiology in infants and bladder dysfunction in conditions such as neurogenic bladder, posterior urethral valves and high grade vesicoureteric reflux. We contrast the classical concept that bladder function in nontoilet-trained children is thought to be 'reflexive' or 'uninhibited', with the results of more recent research showing that infants most commonly have a stable detrusor. The infant bladder is physiologically distinct from the state seen in older children or adults. The voiding pattern of the infant is characterized by an interrupted voiding stream due to lack of proper urinary sphincter relaxation during voiding. This is called physiologic detrusor sphincter dyscoordination and is different from the pathologic 'detrusor sphincter dyssynergy' seen in patients with neurogenic bladder. Urodynamic abnormalities in neonates born with spina bifida are common and depend on the level and severity of the spinal cord malformation. Upper neuron lesions most commonly lead to an overactive bladder with or without detrusor sphincter dyssynergy while a lower neuron lesion is associated with an acontractile detrusor with possible denervation of the external urinary sphincter. In infants with neurogenic bladder, the role of 'early prophylactic treatment (clean intermittent catheterization and anticholinergics)' versus initial 'watchful waiting and treatment as needed' is still controversial and needs more research. Many urodynamic-based interventions have been suggested in patients with posterior urethral valves and are currently under scrutiny, but their impact on the long-term outcome of the upper and lower urinary tract is still unknown. Cumulative data suggest that there is no benefit to early intervention regarding bladder function in infants with high-grade vesicoureteric reflux.
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Affiliation(s)
- Luis Guerra
- Division of Urology, Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Rd, Ottawa, ON, Canada K1H 8L1
| | - Michael Leonard
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Marco Castagnetti
- Section of Paediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
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Fernandes Silva JA, Borges Carrerette F, Damião R. Uroflowmetry in the management of lower urinary tract symptoms of children and adolescents with cerebral palsy. J Pediatr Urol 2014; 10:413-7. [PMID: 23933106 DOI: 10.1016/j.jpurol.2013.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate uroflow measurements in the initial management of lower urinary tract dysfunction in children and adolescents with cerebral palsy. MATERIALS AND METHODS A total of 54 patients was enrolled in this study. All patients reported their urinary symptoms and underwent a physical examination, renal and urinary tract ultrasonography, and uroflow assessment. RESULTS Twenty-three patients were female. Mean age was 9 years and 6 months (SD: 2 years and 10 months), with a range of 5-18 years. Twenty-eight of the patients (51.8%) were symptomatic. Urgency (42.6%), urge incontinence (40.7%), and enuresis (16.7%) were the most frequently observed symptoms. No association was found between gender, ambulatory status, or distribution of the paralysis and uroflow parameters. Symptomatic patients presented a statistically lower maximum flow (Qmax) than asymptomatic patients (17.2 ± 7.8 ml/s vs 22.6 ± 7.5 ml/s, p = 0.013, respectively). Normal bell-shaped curves were observed more frequently in asymptomatic patients, while abnormal curves were observed more frequently in symptomatic patients (p = 0.022). CONCLUSIONS Gender, ambulatory status, and the distribution of the paralysis do not affect Qmax rate or flow pattern. Symptomatic patients present lower Qmax and may also have an abnormal uroflow curve. Uroflowmetry may be useful in the initial urological evaluation.
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Affiliation(s)
- J A Fernandes Silva
- Division of Urology, Pedro Ernesto Memorial Hospital, State University of Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 77 - Vila Isabel, Rio de Janeiro 55-20551-030, Brazil.
| | - F Borges Carrerette
- Division of Urology, Pedro Ernesto Memorial Hospital, State University of Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 77 - Vila Isabel, Rio de Janeiro 55-20551-030, Brazil
| | - R Damião
- Division of Urology, Pedro Ernesto Memorial Hospital, State University of Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 77 - Vila Isabel, Rio de Janeiro 55-20551-030, Brazil
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Gündoğdu G, Kömür M, Avlan D, Sarı FB, Delibaş A, Taşdelen B, Naycı A, Okuyaz C. Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy. J Pediatr Urol 2013; 9:659-64. [PMID: 22921013 DOI: 10.1016/j.jpurol.2012.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
Although lower urinary tract dysfunction (LUTD) in patients with cerebral palsy (CP) has been previously documented by clinical observations and urodynamic tests, its correlation with upper urinary tract deterioration (UUTD) has not been demonstrated. This paper documents symptoms and urodynamic findings of LUTD and their relationship with UUTD in 33 children with CP. By sonography, 4 of these children were found to have UUTD. Age was found to correlate with UUTD, but gender difference and mental or motor functions did not. When comparing urinary symptoms with UUTD, incontinence (n = 31) did not correlate, but on the other hand symptoms of detrusor sphincter dyssynergia (interrupted voiding, urinary retention, hesitancy; n = 5) and culture proven febrile urinary tract infections (n = 4) did. Abnormal urodynamics findings were not diagnostic. We conclude that, apart from incontinence, dysfunctional voiding symptoms and febrile urinary tract infections are valuable indicators of UUTD.
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Affiliation(s)
- Gökhan Gündoğdu
- Pediatric Surgery, Bezmialem Vakif University, Medical Faculty, Department of Pediatric Surgery, Division of Pediatric Urology, Istanbul 34093, Turkey.
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Abstract
AIM To determine the prevalence of symptomatic neurogenic bladder (SNB) and social and functional variables in a large sample of people with cerebral palsy (CP). METHOD The medical records of 214 individuals (96 females, 118 males) with CP between the years 1990 and 2000 were retrospectively reviewed. Individuals with frequency, urgency, or incontinence were assigned Gross Motor Function Classification System levels and underwent cystometrogram/electromyelogram studies. Neurogenic bladders were classified according to the nomenclature of the International Continence Society. RESULTS Fifty-two patients had hemiplegia, 42 diplegia, 117 quadriplegia, and three dyskinesia. Educational levels ranged from full special education to those with graduate degrees. Thirty-five individuals in our group aged 5 to 66 years had SNB with a prevalence of 16.4%. The median age for the entire population was 9 years 7 months and for those with SNB 12 years 4 months (range 5-57y). Over 80% of individuals who underwent investigation were found to have spastic hyper-reflexic type bladders. Ninety-one percent obtained total continence or major improvement with conservative care. SNB was documented across the lifespan, educational spectrum, and functional level. Upper urinary tract pathology was infrequent. INTERPRETATION SNB is a common finding in individuals with CP. In most patients it is readily diagnosed and treated with conservative interventions.
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Affiliation(s)
- Kevin P Murphy
- Gillette Children's Specialty Healthcare, Lakewalk Center, Duluth, MN 55805, USA.
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Evaluation of carotid intima-media thickness, a marker of subclinical atherosclerosis, in children with cerebral palsy. Pediatr Radiol 2012; 42:679-84. [PMID: 22450433 DOI: 10.1007/s00247-012-2361-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 10/21/2011] [Accepted: 11/06/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Respiratory and cardiovascular diseases are the most common causes of death in children with cerebral palsy. OBJECTIVE To evaluate sonographic carotid intima-media thickness, an early marker of atherosclerosis, in children with cerebral palsy and in healthy controls. MATERIALS AND METHODS One hundred children with cerebral palsy (65 boys), mean age 6.2 (SD, 2.1) years, and 35 age-matched and sex-matched healthy controls were included. Common carotid artery intima-media thickness was measured sonographically. Differences between patients and controls were evaluated with an independent samples t-test. RESULTS Age, sex distribution and levels of serum lipids were comparable between patients and controls. Average, right and left carotid artery intima-media were thicker in patients compared with controls (mean ± SD, 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.14 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm, respectively; all P < 0.001). CONCLUSION Carotid intima-media is sonographically thicker in children with cerebral palsy compared with healthy controls, which may express an increased risk of atherosclerotic diseases.
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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