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Intermittent Catheterization (intermittent + catheterization)
Kinds of Intermittent Catheterization Selected AbstractsIndependence in the toilet activity in children and adolescents with myelomeningocele , managing clean intermittent catheterization in a hospital settingACTA PAEDIATRICA, Issue 12 2009M Donlau Abstract Aim:, The aim of this study was to identify and describe gross motor, fine motor, executive and time-processing obstacles for independence in children with myelomeningocele who are treated with Clean Intermittent Catheterization and to relate their opinions about their performance in the toilet activity, and their medical records, to the observed outcome. Methods:, In a hospital setting, 22 children with myelomeningocele were observed using a structured information form while performing their toilet activity, and tested for time processing ability with the Ka-Tid instrument. Results:, Only five children were independent, despite the fact that 12 of 22 children were completely satisfied with their toilet activity. Neither the degree of motor impairment, nor sex or age had any significant impact on performing the toilet activity. The ability to remain focused on the toilet activity proved to have no relation to age or learning disabilities. The medical records for the children were only able to classify approximately three quarters correctly with respect to independence. The only measurement that could suggest anything in relation to a maintained focus was time processing ability. Conclusion:, The children were unaware of their abilities and limitations. Time processing ability and observations are important factors to assess independence. [source] Alfuzosin in the treatment of high leak-point pressure in children with neurogenic bladderBJU INTERNATIONAL, Issue 7 2002H. Schulte-Baukloh Objective ,To decrease the detrusor leak-point pressure (LPP) of >,40 cmH2O in children with a neurogenic bladder, using the ,1 -adrenergic blocking agent alfuzosin. Patients and methods ,Videocystometry was used to measure the detrusor LPP and several other variables before and 3 weeks after the oral administration of alfuzosin (2.5,7.5 mg/day) in 17 children (mean age 6.3 years) with an upper motor neurone lesion. Results ,The mean (sd) detrusor LPP decreased from 68 (37) to 46 (31) cmH2O (P < 0.01), reflex volume (defined as the volume at the first uninhibited bladder contraction of >,15 cmH2O) increased from 78 (69) to 112 (118) mL (+ 44%), bladder compliance increased from 9.3 (6.1) to 19.6 (14.6) mL/cmH2O (+ 111%), maximal vesical pressure decreased from 84 (40) to 70 (47) cmH2O (, 17%), and the mean number of uninhibited bladder contractions decreased from 6.3 to 3.5 (, 44%). The therapy was well tolerated; side-effects were rare and not severe. Intermittent catheterization could be avoided in six children. Conclusion ,Alfuzosin decreases the detrusor LPP in children with a neurogenic bladder caused by an upper motor neurone lesion, significantly and therapeutically, and should be considered as an alternative or addition to intermittent catheterization and anticholinergic drugs in selected patients. [source] Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Kumiko Kato Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source] Long-term functional outcomes in patients with various types of orthotopic intestinal neobladderINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2008Hideaki Miyake Objectives: To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB). Methods: Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively. Results: Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups. Conclusions: Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based. [source] Self-sterilizing catheters with titanium dioxide photocatalyst thin films for clean intermittent catheterization: Basis and study of clinical useINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2007Yuki Sekiguchi Objective: Clean intermittent catheterization (CIC) requires a large number of disposable catheters or a large amount of water and disinfectant. We made titanium dioxide (TiO2)-coated catheters for CIC using technology we have developed previously, and examined the photocatalytic antibacterial effect of this catheter using only light energy and the safety of this type of catheter for practical clinical use. Methods: TiO2 -coated catheters were filled with bacterial cell suspensions and illuminated with a 15-W black-light lamp for testing antibacterial potency. Next, we soaked control toxic materials (zinc diethyldithiocarbamate) and the tips of TiO2 -coated catheters in M05 medium, and evaluated cell toxicity from the numbers of V79 colonies in these dilutions. Then, bodyweight curves and histological tissue changes were observed over a period of time in mouse-transplanted TiO2 -coated catheters and control catheters. Finally, we investigated the use of these TiO2 -coated catheters in 18 patients by questionnaire and bacterial culture of TiO2 -coated catheters and control catheters. Results: The survival rate of Escherichia coli in the liquid inside the TiO2 catheter decreased to a negligible level within 60 min under ultraviolet (UV)-A illumination. The survival rate of Staphylococcus aureus, Pseudomonas aeruginosa and Serratia marcescens also decreased to a negligible level within 60 min. V79 cells showed no cytotoxicity of this catheter, and there was no difference in bodyweight or foreign body reaction between mouse-transplanted TiO2 -coated catheters and control catheters. In a preliminary clinical analysis of 18 patients who voluntarily used this catheter, the rate of positive bacterial culture of the tips of TiO2 -coated catheters was 20% versus 60% for conventional catheters after 4 weeks of use. Conclusion: TiO2 -coated silicone catheters were easily sterilized under certain light sources and were shown to be safe in an experiment using cultured cells and in animal experiments. Sterilizing catheters with TiO2 photocatalyst thin films are expected to be used clinically for clean intermittent catheterization after proper modification based on this study. [source] Urodynamic findings in children with cerebral palsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2005M IHSAN KARAMAN Abstract Aim: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. Methods: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. Results: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor,sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. Conclusions: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment. [source] Perinephric urinoma secondary to neurogenic bladder with vesicoureteral reflux: Report of an adult caseINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2004KAZUTOSHI FUJITA Abstract We report a case of infectious perinephric urinoma in a 73-year-old woman who had a neurogenic bladder with vesico-ureteral reflux. The patient was admitted to our emergency room with right lumbago and high fever. Ultrasounds and computed tomography demonstrated a right large perinephric cystic mass, bilateral hydronephrosis and much residual urine. Percutaneous drainage of the cystic mass was performed with an indwelling urethral catheter. The content of the mass was urine infected with Escherichia coli. Antibiotic therapy was performed successfully and we then examined the cause of the urinoma. A urodynamic study demonstrated a low-compliance small bladder and detrusor,sphincter dyssynergia. A voiding cystourethrogram revealed right grade III vesicoureteral reflux. The patient was unable to be cleared with intermittent catheterization and had an indwelling urethral catheter inserted. In 1 year, the voiding cystourethrogram showed no vesicoureteral reflux and the patient was well with no evidence of recurrent urinoma without the urethral catheter. There have been only two reported cases of urinoma caused by neurogenic bladder with vesico-ureteral reflux in children and this is the first case reported in an adult. [source] Appendicovesicostomy for pubescent patients with neurogenic bladder using umbilicus as a stomal siteINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Akiko Uda Abstract We experienced two cases of neurogenic bladder in which clean intermittent catheterization (CIC) had been performed since early childhood. In both cases, CIC had not provided adequate voiding control and incontinence persisted. According to the Mitrofanoff Principle, we used the appendix as a catheterizable conduit, which was constructed to the umbilicus. [source] Long-term results of Burch colposuspensionINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000Haluk Akpinar Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source] Management of Low Compliant Bladder in Spinal Cord Injured PatientsLUTS, Issue 2 2010Won Hee PARK Low bladder compliance means an abnormal volume and pressure relationship, and an incremental rise in bladder pressure during the bladder filling. It is well known that at the time bladder capacity decreases, intravesical pressure increases, and the risk of upper deterioration increases. Hypocompliance is usually thought to be the range from 1.0 to 20.0 mL/cmH2O. Though the exact cause of hypocompliance is not known, it may be caused by changes in the elastic and viscoelastic properties of the bladder, changes in detrusor muscle tone, or combinations of the two. Management aims at increasing bladder capacity with low intravesical pressure. The main is a medical therapy with antimuscarinics combined with clean intermittent catheterization. The results are sometimes unsatisfactory. Various drugs or agents through the mouth or the bladder, including oxybutynin, new antimuscarinics, capsaicin and resiniferatoxin were tried. Among them botulinum toxin-A is promising. Some patients eventually required surgical intervention in spite of the aggressive medical therapy. Finally most patients undergo the surgical treatment including autoaugmentation, diversion, and augmentation cystoplasty. Among them augmentation cystoplasty still seems the only clearly verified treatment method. [source] Ileovesicostomy for adults with neurogenic bladders: Complications and potential risk factors for adverse outcomes,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2008Hung-Jui Tan Abstract Aims Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications. Methods Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003. Demographic, pre-operative, and post-operative data were extracted. Statistical analysis determined whether risk factors influenced outcomes of urethral continence, re-operation, and post-operative complications. Factors included age, tobacco use, diabetes, neurogenic bladder etiology, body mass index, pre-operative indwelling catheterization, or simultaneous procedures including pubovaginal sling/urethral closure. Results 50 adults status-post ileovesicostomy were identified. At last follow-up, 36 patients (72%) were continent per urethra. The incidence of complications decreased significantly from 3.38 per patient to 1.16 post-operatively (P,<,0.0001). Twenty-seven averaged 1.52 inflammatory or infectious post-operative complications per patient, 19 averaged 1.47 stomal complications, and 11 averaged 2.09 ileovesicostomy mechanical obstructions. Overall, 27 required 2.85 re-operations or additional procedures following ileovesicostomy. Sub-group analysis identified BMI (P,=,0.0569) as a possible risk factor. Differences in outcomes based on age, tobacco use, diabetes, neurogenic bladder etiology, pre-operative indwelling catheterization, or urethral closure were not significant. Conclusions Ileovesicostomy is a valuable management option for adults with neurogenic bladder unable to perform intermittent catheterization. The incidence of urinary tract comorbid events significantly decreased following ileovesicostomy though the onset of other complications should be considered. The morbidity associated with ileovesicostomy requires careful patient selection, close long-term follow-up, and potential subsequent interventions to address post-operative complications. Neurourol. Urodynam. 27:238,243, 2008. © 2007 Wiley-Liss, Inc. [source] Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in ChildrenANZ JOURNAL OF SURGERY, Issue 4 2010Aniruddh V. Deshpande Abstract Background:, We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder. Methods:, This was a prospective, non-randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance and had failed treatment with anticholinergic medications were offered a single intra-detrusor injection of Botulinum A toxin. All subjects were on clean intermittent catheterization before and during the study. Follow-up videourodynamic studies were performed at 1 month, between 3 and 6 months, and at 9 months. Data were collected on safety and on subjective outcomes through validated questionnaires filled out by patients at each visit. Results:, In majority of the patients (5/7), the injection produced an increase in bladder compliance (P < 0.05) and an improvement in incontinence (P < 0.05) at 1-month follow-up. However, in two patients whose baseline bladder capacity was markedly reduced (<200 mL), the improvement was very minimal. The beneficial effects in bladder compliance and incontinence dissipated by 9 months. The changes in subjective outcomes (incontinence and satisfaction scores) did not parallel the changes in urodynamics through the study period. No side effects of Botulinum toxin were seen. Conclusion:, Botulinum A toxin injection produces beneficial urodynamics and clinical effects. These beneficial effects last for approximately 9 months. There is a poor correlation between improvement in the urodynamics and the subjective outcomes. Botulinum A toxin injection is a safe alternative treatment for patients with spina bifida and a neurogenic bladder. [source] Colpo-wrap: a new continence procedureBJU INTERNATIONAL, Issue 7 2005Thomas M. Boemers OBJECTIVE To present a new surgical method to increase bladder outlet resistance for the treatment of urinary incontinence in girls and women. PATIENTS AND METHODS Six patients (mean age 9.6 years), with urinary incontinence were operated using the new technique within the last 3 years. The principle of the procedure is tightening of the bladder neck by mobilizing the anterior vaginal wall and wrapping it around the bladder neck and proximal urethra, in the sense of a vaginoplication (colpoplication). The underlying conditions and causes for urinary incontinence was neurogenic bladder-sphincter dysfunction caused by myelodysplasia in three girls and anorectal malformation combined with a tethered spinal cord in one. In one case incontinence was caused by a cloacal anomaly and one girl had intrinsic sphincter insufficiency after repetitive Otis urethrotomies. The colpo- wrap was combined with a bladder augmentation and Mitrofanoff in three patients, the three other girls undergoing isolated procedures. RESULTS The result of the method is a constant increase in outlet resistance and coaptation of the urethra, comparable with the effect of a vaginal sling procedure. Five patients are completely dry after surgery, one girl with cloaca needed an additional bladder neck injection with hyaluranon/dextranomer copolymer. Transurethral catheterization was possible after surgery with no problems in all patients who required intermittent catheterization. CONCLUSION Considering the feasibility of this technique the colpo-wrap is a reasonable alternative for treating urinary incontinence in females. [source] Experience with non-cycled artificial urinary sphinctersBJU INTERNATIONAL, Issue 7 2004C.D.A. Herndon Papers in this section review experience with artificial urinary sphincters, hypospadias, and the exstrophy/epispadias complex. Also, in keeping with a significant theme of urological trauma in this issue of the journal, authors from Mansoura evaluate the late renal functional and morphological evaluation of high-grade renal injuries in children after conservative treatment. OBJECTIVE To report our experience in children and adolescents with a non-cycled artificial urinary sphincter. While some children with the AUS can void, others require clean intermittent catheterization (CIC) through the sphincter or an alternative site for catheterization; in some of the latter we have either not cycled (pumped) an activated AUS or the AUS has failed, and there is concern about ischaemia in some adults with a non-cycled AUS. PATIENTS AND METHODS In all, 143 patients who had an AUS placed between 1980 and 2002 were reviewed retrospectively; 15 (10 boys and five girls) no longer cycled (pumped) their AUS. The mean age at AUS insertion was 11 years and the mean (range) follow-up after insertion was 10.4 (1.64,22.2) years. The diagnoses included myelomeningocele in 11, sacral agenesis in three and cloaca in one. Nine patients have an activated functioning AUS and in six the AUS does not function; in the first nine the sphincter has not routinely been cycled (pumped) for a mean (range) of 1.6 (0.6,2.9) years. In the other six with a nonfunctioning AUS the mean (range) observation period is 6.4 (1.5,10) years since the system has not functioned. RESULTS All patients were completely continent, including the six with a nonfunctioning AUS. After inserting the AUS, two patients voided in combination with CIC (one each urethral and abdominal stoma) and 13 emptied by CIC (nine abdominal stoma, four urethral). There was a mechanical complication in eight patients; three had the AUS repaired and are dry, and five are dry with no repair. In one patient the AUS was never activated. To date there has been no erosion of the cuff in any of the 15 patients with a non-cycled AUS. CONCLUSION The AUS remains an extremely reliable procedure to achieve continence in children and young adults. It is versatile and can be combined with other procedures that provide an alternative means for catheterization. While some have noted the need to routinely cycle the AUS to prevent erosion, this has not been our experience in these 15 patients. [source] A multi-institutional studyof orthotopic neobladders: functional results in men and womenBJU INTERNATIONAL, Issue 6 2004R. Carrion Multi-institutional studies are extremely valuable whena new surgical technique is being introduced. The Confederationof American Urology conducted such a study into the functional results inmales and females of the orthotopic bladder. In a series of 138patients they found many interesting outcomes, which they presenthere. Authors from Sheffield describe their experience in developing tissue-engineeredbuccal mucosa for use in urethral reconstruction. They describetheir technique and report the successful culture of full-thicknessbuccal mucosa, which they found to be robust and safe for clinicaluse. OBJECTIVES To analyse the incidence of diurnal incontinence (DI) and nocturnalincontinence (NI), the need for intermittent catheterization (IC),and the rate of ureteric obstruction (UO) among a group of men andwomen with ileal and colonic orthotopic neobladders in four countries. PATIENTS AND METHODS In all, 138 patients (113 men and 25 women) had an orthotopicneobladder constructed after radical cystectomy for carcinoma. The mean(range) age was 61.3 (28,76) years and thefollow-up 41 (6,144) months. All patients underwentsurgery by experienced surgeons associated with the Confederationof American Urology. A retrospective evaluation was designed toreview the functional results and the incidence of UO. The techniqueof orthotopic neobladder construction was at each surgeon's discretion. Various detubularized bowelsegments were used, including ileum, colon or sigmoid. Patients werefollowed by chart reviews and personal interviews at 1, 3 and 6 monthsafter surgery and then every 6 months, and were evaluated bya physical examination, urine analysis, cytology and renal ultrasonography. RESULTS An ileal or colonic neobladder was constructed in 74 and 64 patients, respectively. Five (7%), 23 (31%), 10 (14%) and 14(9.6%) with an ileal neobladder developed DI, NI, IC andUO, respectively; the respective values for patients with a colonicneobladder were eight (12%), 19 (30%), seven (11%)and 15 (12%). Statistical analysis by Fisher'sexact test showed no significant differences between the ileal andcolonic neobladder groups or with gender. CONCLUSIONS Using this specific protocol for evaluating many men and womenwith ileal and colonic orthotopic neobladders showed no significant differencesin the incidence of DI, NI, IC or UO. Neobladders constructed fromdetubularized bowel, irrespective of bowel segment(s) used, canprovide satisfactory diurnal results. A moderate incidence of NIand UO continue to be a problem. [source] Severe perineal pain after enterocystoplasty in bladder exstrophyBJU INTERNATIONAL, Issue 6 2004S.R. Phelps OBJECTIVE To describe a previously unreported complication (severe perineal pain) after bladder reconstruction and enterocystoplasty in patients with bladder exstrophy. PATIENTS AND METHODS The notes were reviewed retrospectively for four patients (two boys and two girls) with classical bladder exstrophy who had severe penile or perineal pain after bladder reconstruction. They were all continent and using intermittent catheterization. A range of conservative management failed and all patients subsequently required excision of their native bladders between 1997 and 2000. RESULTS All four patients had perineal or penile pain which began 4 months to 8 years after bladder augmentation. Investigations included plain abdominal X-ray, renal and bladder ultrasonography, computerized tomography of the pelvis, video-urodynamics and cysto-urethroscopy. When therapeutic interventions such as more frequent bladder washouts, analgesic and anticholinergic drugs, and cystolithotomy (two patients) were unsuccessful in alleviating the symptoms, all had their native bladder excised. Histological examination of the excised tissue showed neither normal urothelium nor enteric mucosa at the margins of the excision; two patients already had squamous metaplasia within what represented the bladder, and in the others squamous epithelium was present amongst the enteric mucosa. All four children were pain-free with a follow-up of 2,6 years. CONCLUSION All four patients developed severe referred bladder pain that was probably secondary to the abnormal retained bladder remnants. Cystectomy cured the pain and may also have removed a potential site of future malignant tumour. [source] Expanded PTFE bladder neck slings for incontinence in children: the long-term outcomeBJU INTERNATIONAL, Issue 1 2004P. Godbole OBJECTIVE To assess the long-term outcome of circumferential expanded PTFE (Gore-texTM, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder. PATIENTS AND METHODS The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization. RESULTS Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one. CONCLUSION Although in the short term this technique had favourable results, it was not a useful technique in the long term. [source] Long-term results of orthotopic neobladder reconstruction after radical cystectomyBJU INTERNATIONAL, Issue 6 2003J.N. Kulkarni Objective To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer. Patients and methods Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded. Results In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36,144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died. Conclusions Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates. [source] Alfuzosin in the treatment of high leak-point pressure in children with neurogenic bladderBJU INTERNATIONAL, Issue 7 2002H. Schulte-Baukloh Objective ,To decrease the detrusor leak-point pressure (LPP) of >,40 cmH2O in children with a neurogenic bladder, using the ,1 -adrenergic blocking agent alfuzosin. Patients and methods ,Videocystometry was used to measure the detrusor LPP and several other variables before and 3 weeks after the oral administration of alfuzosin (2.5,7.5 mg/day) in 17 children (mean age 6.3 years) with an upper motor neurone lesion. Results ,The mean (sd) detrusor LPP decreased from 68 (37) to 46 (31) cmH2O (P < 0.01), reflex volume (defined as the volume at the first uninhibited bladder contraction of >,15 cmH2O) increased from 78 (69) to 112 (118) mL (+ 44%), bladder compliance increased from 9.3 (6.1) to 19.6 (14.6) mL/cmH2O (+ 111%), maximal vesical pressure decreased from 84 (40) to 70 (47) cmH2O (, 17%), and the mean number of uninhibited bladder contractions decreased from 6.3 to 3.5 (, 44%). The therapy was well tolerated; side-effects were rare and not severe. Intermittent catheterization could be avoided in six children. Conclusion ,Alfuzosin decreases the detrusor LPP in children with a neurogenic bladder caused by an upper motor neurone lesion, significantly and therapeutically, and should be considered as an alternative or addition to intermittent catheterization and anticholinergic drugs in selected patients. [source] The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal childrenBJU INTERNATIONAL, Issue 9 2002H.G. Pohl Objective,To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. Patients and methods,The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6,14.5, and seven males, mean age 8 years, range 5,20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. Results,Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. Conclusion,CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively. [source] Independence in the toilet activity in children and adolescents with myelomeningocele , managing clean intermittent catheterization in a hospital settingACTA PAEDIATRICA, Issue 12 2009M Donlau Abstract Aim:, The aim of this study was to identify and describe gross motor, fine motor, executive and time-processing obstacles for independence in children with myelomeningocele who are treated with Clean Intermittent Catheterization and to relate their opinions about their performance in the toilet activity, and their medical records, to the observed outcome. Methods:, In a hospital setting, 22 children with myelomeningocele were observed using a structured information form while performing their toilet activity, and tested for time processing ability with the Ka-Tid instrument. Results:, Only five children were independent, despite the fact that 12 of 22 children were completely satisfied with their toilet activity. Neither the degree of motor impairment, nor sex or age had any significant impact on performing the toilet activity. The ability to remain focused on the toilet activity proved to have no relation to age or learning disabilities. The medical records for the children were only able to classify approximately three quarters correctly with respect to independence. The only measurement that could suggest anything in relation to a maintained focus was time processing ability. Conclusion:, The children were unaware of their abilities and limitations. Time processing ability and observations are important factors to assess independence. [source] | ||||||||||