Effects of sacral dorsal rhizotomy on bladder function in patients with spastic cerebral palsy

Sweetser, Philip M.; Badell, Angeles; Schneider, Steven J.; Badlani, Gopal H.

doi:10.1002/nau.1930140110

Cited by 23 publications

(23 citation statements)

References 27 publications

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“…One might anticipate that SDR, especially if it involves the S2 roots, would reduce the spasticity in the external sphincter mechanisms and decrease the contractility of the bladder wall. In a child with an upper motor neurone bladder, this could improve bladder capacity and control, and such beneficial effects have been reported after SDR in half of symptomatic children with spastic diplegic cerebral palsy [35]. On the other hand, a change in the sphincter or bladder wall mechanisms could be detrimental for some children, and lead to urinary incontinence or retention.…”

Section: Deterioration Of Bladder/bowel Controlmentioning

confidence: 99%

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Steinbok

Schrag²

1998

Pediatr Neurosurg

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Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia’s Children’s Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.

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Section: Deterioration Of Bladder/bowel Controlmentioning

confidence: 99%

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Steinbok

Schrag²

1998

Pediatr Neurosurg

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“…Selective dorsal rhizotomy improved bladder storage characteristics, and the authors of that report propose that urodynamic studies be included in the evaluation of these children [58]. Almost half the patients with spastic diplegia and urinary incontinence gained continence after posterior rhizotomy [59]. However, posterior rhizotomy did not improve urinary incontinence in patients with spastic quadriplegia [59].…”

Section: Outcomes Of Posterior Rhizotomymentioning

confidence: 99%

“…Almost half the patients with spastic diplegia and urinary incontinence gained continence after posterior rhizotomy [59]. However, posterior rhizotomy did not improve urinary incontinence in patients with spastic quadriplegia [59]. …”

Section: Outcomes Of Posterior Rhizotomymentioning

confidence: 99%

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

et al. 2001

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Spasticity occurs in children and adults due to a wide range of conditions, including cerebral palsy, head and spinal cord trauma, cerebrovascular accidents and multiple sclerosis. Multiple treatment options have been described, including medical and surgical treatments. Medical treatments include intramuscular botulinum A toxin, oral baclofen and supportive bracing. Surgical approaches include selective posterior rhizotomy, intrathecal baclofen and orthopedic procedures to address deformities. Many reports have been published on these different treatment options, but rarely has a comparison been made between them. Therefore, this review is aimed at comparing selective posterior rhizotomy and intrathecal baclofen injection for spasticity due to cerebral palsy, especially in children.

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“…[1][2][3] Neurogenic bladder has been associated with incontinence in the population with CP and is the focus of several studies. [4][5][6] McNeal et al 7 from the University of Iowa screened 50 patients with CP and 18 patients with one or more symptoms indicative of a neurogenic bladder were identified. At least four were found to have a neurogenic bladder on urological assessment including cystometrograms.…”

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confidence: 99%

Cerebral palsy, neurogenic bladder, and outcomes of lifetime care

Murphy

Boutin

Ide

2012

Develop Med Child Neuro

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ABBREVIATION SNB Symptomatic neurogenic bladderAIM 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 hyperreflexic 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.Incontinence has long been identified as a problem in people with cerebral palsy (CP).1-3 Neurogenic bladder has been associated with incontinence in the population with CP and is the focus of several studies. [4][5][6] McNeal et al.7 from the University of Iowa screened 50 patients with CP and 18 patients with one or more symptoms indicative of a neurogenic bladder were identified. At least four were found to have a neurogenic bladder on urological assessment including cystometrograms. Significant improvement was identified in symptomatic patients on medication.Decter et al. 8 from Boston evaluated voiding functions including cystometrograms and electromyography findings of the external urinary sphincter in 57 children with CP. Eightysix percent of the children had evidence of an upper motorneuron injury. Treatment protocols achieved continence in more than 75% of the children.Studies by Drigo et al., 9 Karaman et al., 10 and Bross et al. 11of children with CP all found urodynamic features consistent with neurogenic bladder, detrusor sphincter dyssynergia, and upper motoneuron etiology. As noted by Borzyskowski,12 there are many factors involved in bladder control in people with CP. These factors include age, cognitive and communication skills, mobility, and upper extremity function together with expectations, training, and a compatible living environment. Incontinence in the population with CP is, thus, much more complicated than a static pathology of the central nervous system and associated measured bladder function.The purpose of this study ...

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Effects of sacral dorsal rhizotomy on bladder function in patients with spastic cerebral palsy

Cited by 23 publications

References 27 publications

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

Cerebral palsy, neurogenic bladder, and outcomes of lifetime care

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