Spina Bifida. Modern approaches and opportunities for diagnosis, treatment and rehabilitation

MOROZOV, S. L.; Polyakova, Olga; YANOVSKAYA, N. V.; ZVEREVA, A. V.; Длин, В. В.

doi:10.32000/2072-1757-2020-3-32-37

Cited by 5 publications

(6 citation statements)

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“…Ключевые слова: дети, нейрогенная дисфункция мочевого пузыря, нарушения мочеиспускания, уродинамика, урофлоуметрия, цистометрия, ГАМП, КУДИ _________________________________________________________________________________________________  ВВЕДЕНИЕ Одной из актуальных проблем педиатрической практики является нарушение мочеиспускания (НМ) у детей, что, несомненно, требует внимания со стороны многих специалистов, таких как педиатр, нефролог, уролог, невролог и др. По мнению отечественных исследователей, частота нарушений мочеиспускания в популяции составляет примерно 10% [1][2][3].…”

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“…Чаще всего у детей встречается гиперактивный мочевой пузырь (ГАМП) -нарушение функции мочевого пузыря в фазу накопления, специфическая дисфункция мочевого пузыря, клинически проявляющаяся полным или неполным синдромом императивного мочеиспускания (поллакиурия, императивные позывы, императивное недержание мочи и ноктурия). На втором месте по частоте у детей находятся «дисфункциональные мочеиспускания», обусловленные нарушением взаимодействия сфинктерного аппарата мочевого пузыря и мышц тазового дна при сокращении [1, 2,7,8].…”

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“…Исходя из того, что нарушение функции мочевого пузыря возникает еще внутриутробно, требуется выявить возможное повреждение верхних мочевых путей. Для этого проводят ультразвуковое исследование почек на 5-7-й день после родов с оценкой состояния паренхимы почек, ее кровоснабжения и степени дилатации собирательной системы [2].…”

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“…Частыми ее формами у новорожденных являются незаторможенный мочевой пузырь, детрузорно-сфинктерная диссинергия и тотальное недержание мочи вследствие паралича сфинктерного аппарата. Чаще других встречаются две первые формы [2,11].…”

Section: резюме _____________________________________________________...unclassified

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Urodynamic Techniques in Clinical Practice as the "Gold Standard" for Examining Children with Urinary Disorders (A Lecture)

Морозов¹,

Длин²,

Подгорный³

et al. 2023

Педиатрия. Восточная Европа

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Одной из актуальных проблем педиатрической практики является нарушение мочеиспускания у детей, что обусловлено высокой частотой в детской популяции, кроме того, проблема актуальна не только в связи с ее высокой распространенностью, но и ухудшением качества жизни. Также большое значение для пациентов с нейрогенными расстройствами имеет развитие вторичных осложнений: пузырно-мочеточниковый рефлюкс, вторичный обструктивный пиелонефрит, поражение верхних мочевых путей (мегауретер, гидронефроз, рефлюкс-нефропатия), инфекция мочевой системы (цистит, пиелонефрит), гипертрофия и фиброз мочевого пузыря. Для эффективного лечения и предотвращения осложнений нейрогенного мочевого пузыря важной остается функциональная диагностика расстройств мочеиспускания. В настоящее время одним из современных методов для категоризации нейрогенных расстройств является клиническое уродинамическое исследование, в том числе и у детей первого года жизни. Современные подходы к диагностике позволяют правильно определить тип дисфункции мочевого пузыря и дальнейшую тактику ведения пациента с расстройствами мочеиспускания. Помимо диагностики различных вариантов нейрогенного мочевого пузыря большая роль клинического уродинамического исследования отмечена в контроле эффективности терапии, особенно у детей раннего возраста. One of the topical problems in pediatric practice is urinary dysfunction in children, owing to its high prevalence in pediatric population; moreover, this problem is relevant not only due to its high prevalence, but also because it worsens the quality of life. Furthermore, of great importance for patients with neurogenic disorders is the development of secondary complications: vesicoureteral reflux, secondary obstructive pyelonephritis, upper urinary tract involvement (megaureter, hydronephrosis, and reflux nephropathy), urinary infection (cystitis, pyelonephritis), bladder hypertrophy and fibrosis. For effective treatment and prevention of neurogenic bladder complications, functional diagnosis of urination disorders remains important. Currently, one of the modern methods for neurogenic disorders categorization is clinical urodynamic investigation, including that in children of the first year of life. Modern approaches to diagnosis allow correctly determining bladder dysfunction type and further management tactics for patients with urination disorders. In addition to diagnosing various variants of neurogenic bladder, a great contribution of clinical urodynamic investigations is highlighted in monitoring therapy effectiveness, especially in young children.

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Urodynamic Techniques in Clinical Practice as the "Gold Standard" for Examining Children with Urinary Disorders (A Lecture)

Морозов¹,

Длин²,

Подгорный³

et al. 2023

Педиатрия. Восточная Европа

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“…Exposed nerve tissue degenerates in utero, resulting in various neurological deficits and varies with the level of lesion [3,5,10]. In this form of Spina bifida, a part of the spinal cord emerges through the spinal defect in the form of a "pouch" with the spinal cord [11].…”

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confidence: 99%

"A Unique Case of Rehabilitation of a Young Girl with a Bilateral Above the Knee Stumps and Spina Bifida"

AA¹

2021

BJSTR

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A clinical example of rehabilitation of a 26-year-old girl who underwent amputation of both thighs in childhood and who moves in a wheelchair is considered. Concomitant pathology of the spinal cord -the presence of meningomyelocele and open Spina bifida did not allow the fabrication of leg prostheses on the stump of the thighs without preliminary surgical preparation. Long-term sitting position and movement only in a wheelchair led to the formation of contact chronic osteomyelitis of the pelvic bones. A number of staged operations for the treatment of osteomyelitis, correction of spinal deformity in the Spina bifida area were performed. Then, primary prosthetics of the stumps of both thighs was performed, in combination with orthosis (corset made of thermoplastic material) of the lumbar spine. This allowed the patient to be verticalized, who was able to stand and move with the help of a walker. This observation demonstrates a positive result of a multidisciplinary approach to the rehabilitation of patients with a very complex combined pathology of the musculoskeletal system: the spine and lower extremities.

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Results of Cross-Sectional Study of the Opinion from Parents of Children with Clubfoot on Medical Care via Ponseti Method in Outpatient Center of Surgery, Traumatology and Orthopedics

Krest'yashin

Razumovskiy

Krestyashin

et al. 2023

Vopr. sovr. pediatr.

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Background. Patients with clubfoot can have pain and functional disorders that lead to disability. Familiarity of obstetrician-gynecologists, general practitioners, surgeons with its early diagnosis and timely management may prevent disablement.Objective. The aim of the study is to analyze the opinion from parents of children with clubfoot on medical care via Ponseti method in outpatient center of surgery, traumatology and orthopedics.Methods. Cross-sectional study in the form of sociological survey (questionnaire) was carried out in N.F. Filatov Children’s City Hospital from March to December 2021 among parents of children with the following diagnoses: congenital bilateral clubfoot, congenital right clubfoot, congenital left clubfoot.Results. Respondents rated the quality of provided medical care and its availability, the hospital stay conditions by 10.0 points on the scale from 0 to 10. Territorial accessibility of medical care was estimated by 9.0 (7.0; 10.0) points, 30 out of 99 respondents (30.3%) required improvement in territorial accessibility (7 points out of 10 and below). Only 36.4% (36 out of 99) of children were sent to N.F. Filatov Children’s City Hospital for treatment by doctor of out-patient clinic. Others learned about this variant from the Internet, from acquaintances, etc. 10 out of 15 (15.2%) children with disabilities included in the study had difficulties in learning socially necessary skills. None of 10 children who have been diagnosed antenatally had any difficulties in learning socially necessary skills or disabilities. Mean age of disability was 10.6 ± 7.3 months. Children with disease diagnosed since birth had difficulties in learning socially necessary skills in 7.1% (2 out of 28) cases, and in 13.3% (8 out of 60) cases if diagnosed after birth (p = 0.356). Disability did not affect conditions in which children received treatment (14.6% and 20.0% of children under outpatient and inpatient treatment, respectively, had disabilities; p = 0.646). 26.7% of children with disabilities and only 11.9% of children without disabilities received treatment in hospital before the treatment (p = 0.218). 5.9% of children treated on outpatient basis had difficulties with learning socially necessary skills. Children treated on inpatient basis had difficulties with learning socially necessary skills in 35.7% cases (p = 0.005). The choice of outpatient or inpatient treatment did not depend on the presence of spina bifida (p = 0.276), children age (2.1 (0.7; 3.6) months vs 3.65 (0.6; 4.975) months, respectively; p = 0.309).Conclusion. Treatment can be delayed statistically significantly in case of late diagnosis, which is associated with the observed low awareness of doctors (working by the district principle) about specialized medical care. Ratio of children with disabilities and difficulties in learning socially necessary skills or disabilities is lower among patients with antenatal diagnosis. However, further studies are required for evaluation of these factors’ association.

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Spina Bifida. Modern approaches and opportunities for diagnosis, treatment and rehabilitation

Cited by 5 publications

References 0 publications

Urodynamic Techniques in Clinical Practice as the "Gold Standard" for Examining Children with Urinary Disorders (A Lecture)

Urodynamic Techniques in Clinical Practice as the "Gold Standard" for Examining Children with Urinary Disorders (A Lecture)

"A Unique Case of Rehabilitation of a Young Girl with a Bilateral Above the Knee Stumps and Spina Bifida"

Results of Cross-Sectional Study of the Opinion from Parents of Children with Clubfoot on Medical Care via Ponseti Method in Outpatient Center of Surgery, Traumatology and Orthopedics

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