1
|
Growth Hormone (GH) and Rehabilitation Promoted Distal Innervation in a Child Affected by Caudal Regression Syndrome. Int J Mol Sci 2017; 18:ijms18010230. [PMID: 28124993 PMCID: PMC5297859 DOI: 10.3390/ijms18010230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 02/02/2023] Open
Abstract
Caudal regression syndrome (CRS) is a malformation occurring during the fetal period and mainly characterized by an incomplete development of the spinal cord (SC), which is often accompanied by other developmental anomalies. We studied a 9-month old child with CRS who presented interruption of the SC at the L2–L3 level, sacral agenesis, a lack of innervation of the inferior limbs (flaccid paraplegia), and neurogenic bladder and bowel. Given the known positive effects of growth hormone (GH) on neural stem cells (NSCs), we treated him with GH and rehabilitation, trying to induce recovery from the aforementioned sequelae. The Gross Motor Function Test (GMFM)-88 test score was 12.31%. After a blood analysis, GH treatment (0.3 mg/day, 5 days/week, during 3 months and then 15 days without GH) and rehabilitation commenced. This protocol was followed for 5 years, the last GH dose being 1 mg/day. Blood analysis and physical exams were performed every 3 months initially and then every 6 months. Six months after commencing the treatment the GMFM-88 score increased to 39.48%. Responses to sensitive stimuli appeared in most of the territories explored; 18 months later sensitive innervation was complete and the patient moved all muscles over the knees and controlled his sphincters. Three years later he began to walk with crutches, there was plantar flexion, and the GMFM-88 score was 78.48%. In summary, GH plus rehabilitation may be useful for innervating distal areas below the level of the incomplete spinal cord in CRS. It is likely that GH acted on the ependymal SC NSCs, as the hormone does in the neurogenic niches of the brain, and rehabilitation helped to achieve practically full functionality.
Collapse
|
2
|
Cho PS, Bauer SB, Pennison M, Rosoklija I, Bellows AL, Logvinenko T, Khoshbin S, Borer JG. Sacral agenesis and neurogenic bladder: Long-term outcomes of bladder and kidney function. J Pediatr Urol 2016; 12:158.e1-7. [PMID: 26897325 PMCID: PMC4927372 DOI: 10.1016/j.jpurol.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with neurogenic bladder dysfunction that does not necessarily correlate with the level of spinal or skeletal defect. Patients with SA should undergo urodynamic studies (UDS) to guide lower urinary tract (LUT) management. OBJECTIVE This review aimed to update the present institutional experience since 1981 of this rare patient population with detailed, long-term follow-up of bladder and kidney function. STUDY DESIGN A single institution, retrospective, IRB-approved review was performed on patients born after January 1, 1981 with an isolated diagnosis of sacral agenesis without spina bifida, and followed with urologic involvement at Boston Children's Hospital. Records were reviewed for demographics, radiologic imaging, UDS including cystometrogram (CMG) and electromyography (EMG), surgery, and blood chemistries. Comparisons were made between groups of patients based on age at diagnosis, with specific focus on renal function and stability of neurogenic bladder lesion. RESULTS Forty-three patients were identified: 23 female and 20 male. Thirty-seven children (86%) had a known age of diagnosis. Nineteen were diagnosed before 2 months old, including five who were diagnosed prenatally, 11 were diagnosed between 2 and 18 months, and seven were diagnosed after 18 months. All 43 had UDS, with 24 (55.8%) studied at the time of diagnosis (Summary Table). Twenty had serial full UDS, with 30% demonstrating neurourologic instability. None developed end-stage renal disease (ESRD) or required spinal cord detethering. DISCUSSION Many children with SA appeared to be diagnosed prenatally or early in life; SA was mostly identified during evaluation of associated anomalies. Though UDS aid in urologic management, testing was not routinely utilized at the time of diagnosis. CONCLUSIONS This review of long-term follow-up in SA patients showed stable LUT and renal function, with minimal risk of progression to ESRD.
Collapse
Affiliation(s)
- P S Cho
- Department of Urology, Boston Children's Hospital, Boston, USA.
| | - S B Bauer
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - M Pennison
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - I Rosoklija
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - A L Bellows
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - T Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - S Khoshbin
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - J G Borer
- Department of Urology, Boston Children's Hospital, Boston, USA
| |
Collapse
|
3
|
Bicakci I, Turgut ST, Turgut B, Icagasioglu A, Egilmez Z, Yumusakhuylu Y. A case of caudal regression syndrome: walking or sitting? Pan Afr Med J 2014; 18:92. [PMID: 25400859 PMCID: PMC4231316 DOI: 10.11604/pamj.2014.18.92.3683] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/17/2014] [Indexed: 11/11/2022] Open
Abstract
Caudal regression syndrome (CRS) is a congenital disorder which is seen vertebral anomalies in varying degrees from lower thoracic spineto the level of the coccyx. We present a case of CRS which is not intended operation for orthopedic deformities considering functionality. 2, 5 year-old girl referred to our clinic with complaints about walking disability, knee and foot deformities. Patient's mother with unregulated diabetes did not have a history of drug use, radiation exposure and serious illness during pregnancy. Diagnosis had been put during antenatal follow-ups. On physical examination, her lower extremities were hypoplastic and had no muscle activity. Her hips were flexed and abducted, but did not have contractures. Her knees had 75 degrees of flexion contractures with popliteal webs and feet had equinovarus deformity. Frog belly was present due to abdominal muscles weakness. Also hypoplasic labia majora has been identified. In lumbar MRI, spinal cord was terminated at 6th thoracic (T6) vertebrae and the last solid vertebrae level was at T10. Patient who has been following by urology with clean intermittent catheterization had also severe urological problems including horseshoe kidney, neurologic bladder, vesico-ureteral reflux and grade 2 hydronephrosis. Orthopedic consultation was made for her deformities. They decided that ambulation unexpected patient's knee flexion contractures were helping sitting balance. Because of this operation was not considered. Prognosis, treatment options, strength exercises for upper extremities, skin care were told to parents and patient was taken to follow. CRS is a rare congenital abnormality which is associated with orthopedic deformities, as well as urological, anorectal and cardiac malformations. Treatment requires a multidisciplinary approach. It should not be forgotten that purpose of rehabilitation is not to correct all deformities but increase the functionality of everyday life.
Collapse
Affiliation(s)
- Irem Bicakci
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Selin Turan Turgut
- Karaman State Hospital, Physical Medicine and Rehabilitation Clinic, Karaman, Turkey
| | - Bekir Turgut
- Karaman State Hospital, Radiology Clinic, Karaman, Turkey
| | - Afitap Icagasioglu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Zeliha Egilmez
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Yasemin Yumusakhuylu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| |
Collapse
|
4
|
Abstract
OBJECTIVE The authors evaluated rectal manometry of children with sacral root abnormalities secondary to isolated sacral agenesis. METHODS The anorectal manometric recordings of seven patients with isolated sacral agenesis (four with partial agenesis and three with complete agenesis) were retrospectively evaluated and compared with tracings from healthy control subjects. Characteristics of the internal anal sphincter (IAS), the rectoanal inhibitory reflex (RAIR), voluntary external anal squeeze pressure, and threshold of rectal sensation to distension were analyzed. Characteristics of the patients' neurologic function with attention to urinary and fecal continence were obtained by chart review. RESULTS All seven patients had urinary and fecal incontinence. IAS resting pressure was the same in patients and control subjects. In the three patients with total sacral agenesis, IAS relaxation was more complete and lasted longer after balloon distention of the rectum. These patients also had significantly lower voluntary external anal squeeze pressure and blunted sensation of rectal distension. CONCLUSIONS Abnormal parasympathetic innervation associated with sacral agenesis is associated with changes in anorectal function. Manometric findings suggest that there is modulation of the RAIR by extrinsic innervation, which may explain the fecal incontinence in these patients.
Collapse
Affiliation(s)
- Claudio Morera
- Gastrointestinal Motility Unit, Combined Program in Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, U.S.A
| | | |
Collapse
|
5
|
Boemers TM. Urinary incontinence and vesicourethral dysfunction in pediatric surgical conditions. Semin Pediatr Surg 2002; 11:91-9. [PMID: 11973761 DOI: 10.1053/spsu.2002.31807] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The most common cause for urinary incontinence in children with pediatric surgical conditions of the pelvic region and perineum is lower urinary tract dysfunction caused by concomitant sacral agenesis, especially in children with anorectal malformations. Another common cause is iatrogenic pelvic nerve damage secondary to reconstructive surgery. Moreover, an intrinsically altered pelvic floor anatomy as seen in some cases of complex cloacas, or disruption of pelvic floor muscles with consecutive loss of supportive structures, as in sacrococcygeal teratoma, should also be taken into consideration. It is important to understand that the causes of urinary incontinence in these children are not isolated problems concerning only the urinary tract. They may have the same negative impact on anorectal function as they have on the bladder and urethral sphincter. Therefore, children with pediatric surgical conditions of the pelvic and perineal region often will present with a combination of both fecal incontinence caused by anorectal dysfunction and urinary incontinence caused by vesicourethral dysfunction. The additional morbidity caused by urinary incontinence may have an enormous impact on the patient's life and well being, not only with regard to physical disability, but also in terms of emotional problems, social handicap, and socioeconomic burden. It is obvious that a patient's quality of life will be significantly reduced if he or she suffers from both fecal and urinary incontinence. Therefore, an integrated approach to the management of both vesicourethral and anorectal dysfunction should be developed to achieve the optimum care for these children.
Collapse
Affiliation(s)
- Thomas M Boemers
- Department of Pediatric Surgery, Landeskliniken Salzburg, St Johanns Spital, Austria.
| |
Collapse
|
6
|
Aslan H, Yanik H, Celikaslan N, Yildirim G, Ceylan Y. Prenatal diagnosis of Caudal Regression Syndrome : a case report. BMC Pregnancy Childbirth 2002; 1:8. [PMID: 11782287 PMCID: PMC64494 DOI: 10.1186/1471-2393-1-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2001] [Accepted: 12/11/2001] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Caudal regression is a rare syndrome which has a spectrum of congenital malformations ranging from simple anal atresia to absence of sacral, lumbar and possibly lower thoracic vertebrae, to the most severe form which is known as sirenomelia. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. CASE PRESENTATION: We report a case of caudal regression syndrome diagnosed in utero at 22 weeks' of gestation. Prenatal ultrasound examination revealed a sudden interruption of the spine and "frog-like" position of lower limbs. Termination of pregnancy and autopsy findings confirmed the diagnosis. CONCLUSION: Prenatal ultrasonographic diagnosis of caudal regression syndrome is possible at 22 weeks' of gestation by ultrasound examination.
Collapse
Affiliation(s)
- Halil Aslan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- Defne 02 B-10 Daire 17, Bahcesehir Istanbul, Turkey
| | - Halil Yanik
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Nurgul Celikaslan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Gokhan Yildirim
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Yavuz Ceylan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| |
Collapse
|
7
|
Benninga MA, van der Hoeven CW, Wijers OB, Büller HA, Tytgat GN, Akkermans LM, Taminiau JA. Treatment of faecal incontinence in a child with sacral agenesis: the use of biofeedback training. Dev Med Child Neurol 1994; 36:518-27. [PMID: 8005363 DOI: 10.1111/j.1469-8749.1994.tb11882.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The case of a 14-year-old girl is presented who was born with sacral agenesis and severe, chronic constipation not responding to laxative treatment. Biofeedback was employed in the treatment of the constipation and soiling. After six treatment sessions over four months, the constipation and soiling ceased and there was no relapse during follow-up of 12 months. Although this child had an absence of S3-S5 and the coccyx, with possible innervation abnormalities, this case illustrates that biofeedback training might be a useful adjunct to existing therapies.
Collapse
Affiliation(s)
- M A Benninga
- Department of Paediatrics, University Hospital, Utrecht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
8
|
Boemers TM, van Gool JD, de Jong TP, Bax KM. Urodynamic evaluation of children with the caudal regression syndrome (caudal dysplasia sequence). J Urol 1994; 151:1038-40. [PMID: 8126785 DOI: 10.1016/s0022-5347(17)35171-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A total of 50 children with the caudal regression syndrome (caudal dysplasia sequence) underwent urodynamic evaluation of lower urinary tract function. Of the patients 15 had isolated sacral agenesis, 13 had sacral agenesis in combination with an anorectal malformation and 22 had an anorectal malformation without sacral anomaly. Neurogenic bladder-sphincter dysfunction was observed in 11 of the 15 children with isolated sacral agenesis (73%) and in 10 of the 13 children with combined sacral agenesis and anorectal malformation (77%). The pattern of neurogenic bladder-sphincter dysfunction in both groups did not differ significantly. In the group of 22 children with isolated anorectal malformation only 1 had signs of neurogenic bladder-sphincter dysfunction. These results indicate that anorectal malformation per se does not influence lower urinary tract function and that the sacral anomaly is the determining factor for neurogenic bladder-sphincter dysfunction in children with anorectal malformation.
Collapse
Affiliation(s)
- T M Boemers
- Department of Pediatric Urology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | | | | |
Collapse
|
9
|
Abstract
Several malformations and malformation complexes have been alleged to be associated with maternal type 1 diabetes mellitus: in particular, sacral dysplasia, caudal regression/sirenomelia, femoral dysplasia, and holoprosencephaly. For some of the malformations the claim rests on case material, and for others on theoretical considerations. The history and evolution of these ideas are presented.
Collapse
Affiliation(s)
- H Kalter
- Division of Basic Science Research, Children's Hospital Research Foundation, Cincinnati, OH 45229-2899
| |
Collapse
|
10
|
Saito M, Kondo A. Bladder dysfunction in female sacral agenesis. Int Urogynecol J 1993. [DOI: 10.1007/bf00571629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
Saito M, Kondo A, Kato K. Diagnosis and treatment of neurogenic bladder due to partial sacral agenesis. BRITISH JOURNAL OF UROLOGY 1991; 67:472-6. [PMID: 2039916 DOI: 10.1111/j.1464-410x.1991.tb15189.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fifteen patients with partial sacral agenesis were treated over a mean period of 68 months. Partial unilateral agenesis was present in 7 and bilateral sacral agenesis was present in 8. Three important diagnostic features are emphasised: symptoms referable to neurogenic bladder without an obvious neurogenic lesion (all 15 patients); skin or hair abnormalities in the lumbosacral region (9/15) and paraesthesia or other neurological disorders of the lower extremities (8/15). The definitive diagnosis can be made by careful inspection of a plain film of the lumbosacrum. Detrusor contractility was absent in 13 patients but preserved in 2; 11 patients were managed by clean intermittent catheterisation, 2 voided using detrusor contractility and 2 voided by means of the Valsalva/Credé manoeuvre. In 5 patients surgery in the intradural space preserved sexual function and prevented further deterioration in function of the lower extremities but could not restore bladder function that had already deteriorated. Complete continence was achieved in 11 patients and socially acceptable continence in 4. Early diagnosis and conservative treatment with clean intermittent catheterisation are extremely important in management. Should functional deterioration of the bladder and/or sensomotor function of the lower limbs occur, neurosurgery should be performed promptly.
Collapse
Affiliation(s)
- M Saito
- Department of Urology, Nagoya University School of Medicine, Japan
| | | | | |
Collapse
|
12
|
Currarino G, Weinberg A. From small pelvic outlet syndrome to sirenomelia. PEDIATRIC PATHOLOGY 1991; 11:195-210. [PMID: 2052504 DOI: 10.3109/15513819109064759] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report 5 newborns with a contracted lesser pelvis, imperforate anus (severely stenotic and ectopic anus in 1 case), absent or rudimentary urinary tract, and defective or absent external genitalia, vagina, and uterus but normal gonads. The first 2 patients had small pelvic outlet syndrome (SPOS). The findings in the third patient, a possible transition to sirenomelia, were more severe and included malposition of the penis to the posterior sacral area. The fourth and fifth patients had sirenomelia. The remarkable similarity of many abnormalities observed in these cases and related material in the literature suggests that SPOS and sirenomelia may be part of the same malformation complex (SPOS/sirenomelia complex).
Collapse
Affiliation(s)
- G Currarino
- Department of Radiology, Children's Medical Center, Dallas, Texas 75235
| | | |
Collapse
|
13
|
|
14
|
Treble NJ, Owen R, Rickwood AM. Classification of congenital abnormalities of the sacrum. Patterns of associated dysfunctions. ACTA ORTHOPAEDICA SCANDINAVICA 1988; 59:412-6. [PMID: 3048038 DOI: 10.3109/17453678809149393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fifty-eight patients with a congenital abnormality of the sacrum were studied; a modified classification is suggested. Type 1a is characterized by an abrupt termination of the sacrum with an otherwise normal spinal column. Type 1b shows a similar sacral deficit, but with abnormalities evident higher in the spine. In Type 2 the terminal spine is malformed, and in Type 3 there is posterior sacral dysraphism. A high incidence of concomitant congenital abnormalities was found in Types 1 b and 2. Bladder dysfunction in the absence of typical clinical signs was often found in Types 1a and 1b.
Collapse
Affiliation(s)
- N J Treble
- University Department of Orthopedic and Accident Surgery, Royal Liverpool Hospital, Great Britain
| | | | | |
Collapse
|
15
|
Gotoh T, Shinno Y, Koyanagi T. Crossed renal ectopia and asymmetric fused kidney, with special reference to associated vertebral anomalies. Int Urol Nephrol 1987; 19:33-40. [PMID: 3583610 DOI: 10.1007/bf02549675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Crossed renal ectopia and/or asymmetric fused kidney are unusual congenital anomalies. The deformity itself usually produces no symptoms and the clinical presentation generally suggests obstruction and infection. In our series, 10 of 11 patients presented with various vertebral anomalies. A theory of embryogenesis was reviewed to explain asymmetric patterns of renal fusion with special reference to vertebral anomalies.
Collapse
|
16
|
Borrelli M, Bruschini H, Nahas WC, Figueiredo JA, Prado MJ, Spinola R, Walligora M, Freire GC, de Góes GM. Sacral agenesis: why is it so frequently misdiagnosed? Urology 1985; 26:351-5. [PMID: 4049612 DOI: 10.1016/0090-4295(85)90182-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thirty-four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.
Collapse
|
17
|
Yip CM, Leach GE, Rosenfeld DS, Zimmern P, Raz S. Delayed diagnosis of voiding dysfunction: occult spinal dysraphism. J Urol 1985; 134:694-7. [PMID: 3897584 DOI: 10.1016/s0022-5347(17)47390-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The recognition of spinal dysraphism as a potential cause of voiding dysfunction is of the utmost importance if appropriate treatment and followup are to be initiated. We present 2 women with prolonged voiding dysfunction who had spinal dysraphism, intradural lipoma and related urodynamic abnormalities. The importance of initial symptom recognition, physical examination, urodynamic evaluation, appropriate treatment and periodic re-examination to detect progressive neurological impairment is emphasized.
Collapse
|
18
|
Jakobsen H, Holm-Bentzen M, Hald T. Neurogenic bladder dysfunction in sacral agenesis and dysgenesis. Neurourol Urodyn 1985. [DOI: 10.1002/nau.1930040205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Ruelle A, Boccardo M, Mariotti E. Ritenzione Urinaria Rivelatrice Di un Ependimoma Del Filum Terminale: Caso clinico. Urologia 1984. [DOI: 10.1177/039156038405100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Ruelle
- Ente Ospedaliero «Ospedali Galliera» di Genova, Divisione di Neurochirurgia
| | - M. Boccardo
- Ente Ospedaliero «Ospedali Galliera» di Genova, Divisione di Neurochirurgia
| | - E. Mariotti
- Ente Ospedaliero «Ospedali Galliera» di Genova, Divisione di Neurochirurgia
| |
Collapse
|
20
|
|
21
|
Abstract
Among 23 children with the VATER association 21 had significant genitourinary involvement. The extent of these genitourinary anomalies is not generally appreciated. The principal renal anomalies were renal agenesis (7 cases), ureteropelvic junction obstruction (5 cases), crossed fused ectopia (5 cases) and severe reflux (9 cases). Since corrective urologic surgery is commonly beneficial for children with the VATER association, an early and appropriate urologic evaluation is indicated.
Collapse
|