Spinal Cord Injury in Children: Long-Term Urodynamic and Urological Outcomes

Aims:The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of fecal incontinence is also discussed. Methods: Evidence based and consensus committee report. Results: The chapter 'Dynamic Testing' is a continuation of previous Consultation reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. Conclusion: This second part of a series of three articles summarizes the committee's recommendations about: 'Urodynamic testing of male patients with symptoms of incontinence, of patients with relevant neurological abnormalities, testing of children and of frail elderly with symptoms of incontinence' and includes only the most recent and relevant literature references. Neurourol. Urodynam. 29:146-152, 2010. ß 2009 Wiley-Liss, Inc.Key words: consensus committee; incontinence (children); incontinence (frail elderly); incontinence (male); incontinence (neurologic); urodynamics INTRODUCTIONSubsequent to the first two reports of the International Consultation on Incontinence (ICI) 1,2 the chapter ''Urodynamic Testing'' was renamed ''Dynamic Testing'' in the third and fourth reports because of the additional inclusion of recommendations on the (diagnostic) management of fecal incontinence. 3 We (members of ''The ICI 2008 Committee on Dynamic Testing'': ICI-CDT) provide an executive summary of the chapter ''Dynamic Testing'' in the fourth ICI-report on incontinence. 4 The ICI-report, with the ICI-CDT chapter discussed here, has the intention to provide recommendations on the basis of the most reliable evidence for the current state of assessment of the patient with urinary or fecal incontinence. To this aim, dedicated and systematic literature searches were performed on the basis of keywords and on the basis of articles related to references in the previous ICI-reports. Throughout the chapters' text ''conclusion(s)'': solely and entirely based on the published scientific evidence, and ''recommendation(s)'' are highlighted. The ''recommendations'' are the integration of scientific evidence with the expert group consensus, together with the discussion with the attendees during the ICI meeting. Conclusions are separated from recommendations to produce maximum transparency about the ''evidence base'' of the recommendations. Likewise obtained ''topics(s) for research'' are also highlighted in the text of the ICI-report. In this executive summary, we discuss the chapter ''Dynamic Testing'' from the ICI-report in three parts: The innovations in urodynamic techniques ''in general,'' the test characteristics and normal values of urodynamic studies (UDS) as well as the asse...

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“…20 The ICI-CDT recommends that UDS in children with SCI is planned on an individual basis, but not earlier than 6 weeks after injury.…”

Section: Urodynamic Testing In Patients With Relevant Neurologic Abnomentioning

confidence: 99%

Executive summary: The International Consultation on Incontinence 2008—committee on: “Dynamic Testing”; for urinary or fecal incontinence. Part 2: Urodynamic Testing in male patients with symptoms of urinary incontinence, in patients with relevant neurological abnormalities, and in children and in frail elderly with symptoms of urinary incontinence

Szabo

Capewell

Gajewski

et al. 2009

Neurourology and Urodynamics

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“…Other studies also reported that close follow-ups were necessary and appropriate urinary management, which is dependent on the neurological level and type of injury, needed to be conducted for pediatric SCI patients because urodynamic characteristics, including other neurological characteristics, may change with natural growth. 3,4 Thus, urinary management needs to be reconsidered based on the findings of urodynamic evaluations during long-term follow-ups in pediatric SCI patients.…”

Section: Discussionmentioning

confidence: 99%

“…10 Furthermore, since abnormalities such as scoliosis, kyphosis, lordosis and syringomyelia may occur in SCI children with long-term follow-ups, which may induce neurological deterioration, 11 LUT function may be altered during follow-ups with an impact on the kidneys and upper urinary tract. 4,12 Therefore, urodynamics need to be performed in all SCI patients who start or continue self-voiding during follow-ups. Continence is a major issue for many patients on reflex voiding due to spontaneous contractions of the detrusor muscle.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 However, following the introduction of urodynamics, clean intermittent catheterization (CIC) and administration of anticholinergic agents to pediatric SCI patients, the management of lower urinary tract (LUT) with CIC and anti-cholinergic agents, which is dependent on urodynamic outcomes, has prevented hydronephrosis, renal scaring, vesicoureteral reflux (VUR) and bladder trabeculation. [3][4][5] In the present study, we retrospectively summarized the long-term urodynamic and urological outcomes of pediatric-onset SCI.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic pediatric spinal cord injury: long-term outcomes of lower urinary tract function

Mitsui

Kitta

Moriya

et al. 2015

Spinal Cord Ser Cases

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Long-term urodynamic and urological outcomes were evaluated in pediatric patients following traumatic spinal cord injury (SCI). The medical charts of three pediatric patients following traumatic SCI were retrospectively reviewed. The level of the injury was cervical in two patients and thoracic in one. Two patients, whose initial urodynamics demonstrated voluntary or reflex detrusor contraction with synergic sphincter relaxation, managed to void; however, urinary management was switched in one of these patients from voiding to clean intermittent catheterization (CIC) with anti-cholinergic agents because of a treatment for urinary incontinence. There were also no episodes of hydronephrosis, vesicoureteral reflux (VUR) or renal dysfunction in these two patients. Although one patient with hyperreflexic bladder was initially managed with CIC and anti-cholinergic agents, detrusor myectomy was ultimately performed because of severe VUR associated with the progressive worsening of lower urinary tract (LUT) function. Careful follow-ups including urodynamics are mandatory for children with progressively deteriorated LUT function or problematic urinary incontinence.

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“…The authors conclude that with early introduction of CSIC and anticholinergic medications the upper tract changes could be minimised. 10 The aim of this retrospective review is to observe evolution of management over time, report adult urological outcomes and complications in paediatric onset SCI.…”

Section: Introductionmentioning

confidence: 99%

Long-term urological outcomes in paediatric spinal cord injury

et al. 2006

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Spinal Cord Injury in Children: Long-Term Urodynamic and Urological Outcomes

Cited by 31 publications

References 11 publications

Traumatic pediatric spinal cord injury: long-term outcomes of lower urinary tract function

Long-term urological outcomes in paediatric spinal cord injury

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