The Timing of Primary Neurosurgical Repair Significantly Affects Neurogenic Bladder Prognosis in Children With Myelomeningocele

Tarcan, Tufan; Önol, Fikret Fatih; Ilker, Y; Alpay, Harika; Şimşěk, Ferruh; Özek, M. Memet

doi:10.1016/j.juro.2006.04.042

Cited by 46 publications

(31 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A delay can have some impact on vital and functional prognoses, with higher risks of shunt malfunction and CNS infection [14][15][16][17] and worse neurogenic bladder prognosis. 18 In some patients, mostly from PALOP countries, there was a delay in MMC repair due to the unavailability of this procedure in their countries. These data corroborate the findings of Watson et al…”

Section: Discussionmentioning

confidence: 99%

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

Marreiros

Loff

Calado

2014

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

Introduction: Children with myelomeningocele (MMC) are usually subjected to multiple surgeries. However, the number and type of surgeries are not the same in every patient with MMC over time. This report summarizes the surgical interventions in a cohort of several ages. Materials and methods: Data on all of the patients with MMC, aged from 1 year and 10 months to 21 years and 11 months, were retrospectively reviewed at the Dona Estefânia Hospital in Lisbon, Portugal. Data were collected by chart review and individual interviews. The factors analyzed were demographics, ambulatory status, neurological level of involvement, shunt status, Arnold-Chiari malformation type II, surgical history, and occurrence of fracture. The surgical interventions were categorized as neurosurgical, orthopedic, urinary, ulcer repair and others. Results: A total of 84 alive were eligible and enrolled. The average age was 14 years and six months. A total of 59 patients received shunts (all but one ventriculoperitoneal). In the study group, the 84 patients required 663 surgeries. Neurosurgical interventions were the most frequent surgical procedure and predominated during the first 2 years of life. Surgical interventions related to shunts were the most common neurosurgical interventions. Orthopedic surgeries were more frequent in the age group 6-12 years. Urological surgeries were done mainly after 6 years of age. Surgical repair of pressure ulcers was more common after 12 years of age. Conclusions: Our study brings to light the complexity of this condition, with multiple surgeries among patients with MMC.

show abstract

Section: Discussionmentioning

confidence: 99%

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

Marreiros

Loff

Calado

2014

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

show abstract

“…In a retrospective study, early surgical intervention (<72 hours after birth) was found to be associated with a more favorable outcome in terms of urinary symptoms in patients with MMC, and investigators postulated that surgery within the first 24 hours increases the likelihood of maintaining urinary tract function15). In another study where the outcomes of prenatal (in utero) and postnatal surgery were compared, it was observed that prenatal intervention was associated with better motor development while also alleviating the need for shunt placement in most patients.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele

Öncel

Оздемир

Kahiloğulları

et al. 2012

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveTo investigate the effect of surgery time on prognosis of newborns with meningomyelocele.MethodsThe records of neonates with meningomyelocele were retrospectively analyzed. Demographic and clinical characteristics as well as information, timing of surgery, and durations of hospital stay and antibiotic therapy were recorded.ResultsThe records of 30 babies were included in the final analysis. Overall, the mean gestational age was 37.7±2.7 weeks, with a mean birth weight of 2967±755 g and head circumference of 35.8±3.8 cm. In terms of localization, 46.6% of the meningomyeloceles were lumbosacral, 40% were lumbar, 10% were thoracolumbar and 3.3% were thoracal. The mean size of the meningomyelocele sacs was 4.33±1.2 cm. Newborns underwent surgery on average of 8.2±5.9 days after birth, with an overall mean duration of hospital stay of 30±25.1 days. Patients were divided into two groups based on timing of surgery (group 1, ≤5 days; group 2, >5 days), and comparisons between groups revealed that earlier surgery was associated with significantly shorter durations of hospital stay (p<0.001) and antibiotic therapy (p<0.05).ConclusionEarly surgical intervention (≤5 days) was associated with a shorter duration of hospital stay and antibiotic therapy as well as a lower complication rate. We recommend that corrective surgery be undertaken as soon as reasonably possible.

show abstract

“…[101828] In addition to the individual patient, the consequences of delay in care pose a significant pressure on patients’ families and dependents, along with a large burden of cost to the public healthcare system. [10] Through the analysis of sources of delay in accessing medical care in low-income nations, the following themes have emerged as the fundamental causes: Cultural beliefs and practices, financial restrictions, knowledge and skills of primary care providers and the public's perception of same, and transportation.…”

Section: Introductionmentioning

confidence: 99%

Sources of delayed provision of neurosurgical care in a rural kenyan setting

Mansouri¹,

Chan²,

Njaramba³

et al. 2015

Surg Neurol Int

View full text Add to dashboard Cite

Background:Delay to neurosurgical care can result in significant morbidity and mortality. In this study, we aim to identify and quantify the sources of delay to neurosurgical consultation and care at a rural setting in Kenya.Methods:A mixed-methods, cross-sectional analysis of all patients admitted to the neurosurgical department at Kijabe Hospital (KH) was conducted: A retrospective analysis of admissions from October 1 to December 31, 2013 and a prospective analysis from June 2 to June 20, 2014. Sources of delay were categorized and quantified. The Kruskal–Wallis test was used to identify an overall significant difference among diagnoses. The Mann–Whitney U test was used for pairwise comparisons within groups; the Bonferroni correction was applied to the alpha level of significance (0.05) according to the number of comparisons conducted. IBM SPSS version 22.0 (SPSS, Chicago, IL) was used for statistical analyses.Results:A total of 332 admissions were reviewed (237 retrospective, 95 prospective). The majority was pediatric admissions (median age: 3 months). Hydrocephalus (35%) and neural tube defects (NTDs; 27%) were most common. At least one source of delay was identified in 192 cases (58%); 39 (12%) were affected by multiple sources. Delay in primary care (PCPs), in isolation or combined with other sources, comprised 137 of total (71%); misdiagnosis or incorrect management comprised 46 (34%) of these. Finances contributed to delays in 25 of 95 prospective cases. At a median delay of 49 and 200.5 days, the diagnoses of hydrocephalus and tumors were associated with a significantly longer delay compared with NTDs (P < 0.001).Conclusion:A substantial proportion of patients experienced delays in procuring pediatric neurosurgical care. Improvement in PCP knowledge base, implementation of a triage and referral process, and development of community-based funding strategies can potentially reduce these delays.

show abstract

The Timing of Primary Neurosurgical Repair Significantly Affects Neurogenic Bladder Prognosis in Children With Myelomeningocele

Abstract: The timing of primary neurosurgical repair has a significant impact on neurogenic bladder prognosis in children with myelomeningocele. Closure of the spinal lesion on the first day of life seems to provide the best chance for favorable lower urinary tract function.

Cited by 46 publications

References 16 publications

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele

Sources of delayed provision of neurosurgical care in a rural kenyan setting

Contact Info

Product

Resources

About