The Upper Renal Tracts in Adolescents and Young Adults with Myelomeningocele

Am, Rickwood; Dg, Thomas

doi:10.1055/s-2008-1044296

Cited by 3 publications

(3 citation statements)

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“…Toutefois, à l'âge adulte, le risque de détérioration du haut appareil urinaire persiste. Rickwood et Thomas rapportent même qu'il augmente avec l'âge [15]. Nous montrons que 90,3 % des patients avaient consulté leur médecin traitant durant les 24 mois précédents l'enquête.…”

Section: Discussionunclassified

Évaluation du suivi urologique à l’âge adulte des spina bifida avec une myéloméningocèle

Gamé¹,

Moscovici

Bouali

et al. 2007

Pelv Perineol

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Objectifs : Évaluer le suivi urologique des jeunes adultes spina bifida avec une myéloméningocèle et déterminer des facteurs prédictifs de ce suivi. Matériel et méthodes : Entre novembre 2003 et février 2004, une étude transversale a été menée auprès de 131 adultes de plus de 18 ans ayant été consécutivement pris en charge pendant leur enfance en chirurgie pédiatrique viscérale pour une myéloméningocèle. Un autoquestionnaire portant sur les dates des dernières consultations médicales et de la dernière étude du haut appareil urinaire (créatininémie, échographie rénale) et sur la fonction mictionnelle a été adressé par courrier. Les données du dossier hospitalier de chirurgie pédia-trique ont été recueillies.Résultats : Le taux de réponses était de 62,6 %. Durant les deux dernières années, 43 % des répondeurs n'avaient pas eu de suivi spécialisé urologique, 46 % de dosage de la créatininémie et 35 % d'échographie rénale. Les patients ayant consulté en urologie avaient plus d'infections urinaires que ceux qui n'avaient pas consulté (3,2 AE 3,5 vs 1,4 AE 1,9, p = 0,045, test t de Student). Ces derniers avaient plus fréquemment un défaut de relaxation urétrale (29,2 vs 13,1 %, p = 0,026, test exact de Fisher).Conclusion : Le suivi à l'âge adulte des spina bifida avec une myéloméningocèle est insuffisant. Les patients consultant en urologie ont plus d'infections urinaires. À l'inverse, les patients ne consultant pas ont plus fréquemment un défaut de relaxation urétrale.Abstract: Objectives: To assess urological follow-up in young adult spina bifida subjects with myelomeningocele and to determine predictive factors for this follow-up.Material and methods: Between November 2003 and February 2004, a cross-sectional study was conducted in 131 patients aged over 18 years who had been regularly treated for myelomeningocele since their childhood in paediatric internal surgery. A questionnaire relating to most recent medical consultations, most recent upper urinary tract assessments (serum creatinine measurement and kidney ultrasound) and urine function was posted to each patient. Data from paediatric surgery hospital notes were collected.Results: The response rate was 62.6%. During the past two years, 43% of responders have had no specific urological follow-up, 46% have not had any serum creatinine measurements and 35% have not had any kidney ultrasound assessments. Patients who had urology consultations had more urinary tract infections than those who had no consultations (3.2 AE 3.5 vs 1.4 AE 1.9, P = 0.045, Student t test). Patients who had not consulted in urology had more urethral relaxation abnormalities (29.2 vs 13.1%, P = 0.026, Fisher exact test).Conclusion: Follow-up of young adults with spina bifida and myelomeningocele is insufficient. Patients consulting in urology have more urinary tract infections. Conversely, patients who do not consult in urology have more urethral relaxation abnormalities.

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Section: Discussionunclassified

Évaluation du suivi urologique à l’âge adulte des spina bifida avec une myéloméningocèle

Gamé¹,

Moscovici

Bouali

et al. 2007

Pelv Perineol

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“…Continuous eatheter drainage has the associated problems of infeetion and strieture. Colonic or ilealloop diversions are not readily reversible and have fallen into disfavour (3,8).…”

Section: Discussionmentioning

confidence: 99%

Has Vesicostomy a Role in the Neuropathic Bladder?

Connolly¹,

Fitzgerald²,

Guiney³

1988

Eur J Pediatr Surg

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This retrospective study aims to assess the efficacy of vesicostomy in the management of deteriorating upper renal tracts in patients with neuropathic bladders for whom intermittent self catheterization is not a clinical option. Between 1980-1987 vesicostomy was performed in 16 such patients (11 female, 5 male). Eleven had myelomeningocoele, 4 sacral anomalies and one cerebral palsy with scoliosis. All patients had urinary tract infections and deteriorating hydronephrosis and hydroureter (IVP, U/S); associated reflux in 13, impaired GFR in 4 and abnormal biochemistry in 8. The mean age at surgery was 3.3 years (8 mths. to 9 years). In all cases deterioration was arrested by vesicostomy. Fifteen patients showed structural or functional improvement and one stabilized. Late closure of the vesicostomy in two cases resulted in disimprovement of biochemical and radiological parameters. Acceptance of the vesicostomies was good. We advocate vesicostomy as an effective drainage procedure to preserve function in patients with neuropathic bladders and deteriorating renal tracts, in whom intermittent self catheterization is not a realistic alternative.

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“…28 % ont developpe des troubles de l'URT dans l'existence ulterieure. L'intervalle de temps moyen pour observer des modifications de I'URT etait de 33 mois et de There are many studies which have looked at specific aspects of spina bifida patients such as the neuropathie bladder and renal function (6,7,12), but we have found no reports in the recent literature of detailed long-term follow-up of spina bifida children with and without upper renal tract (URT) changes at birth. One hundred and twenty-seven patients were excluded from the study (111 infants died during the first year, one patient did not have early URT assessment, one patient had ectopia vesicae and 14 patients were untraceable).…”

mentioning

confidence: 95%

Follow-Up of Spina Bifida Children with and without Upper Renal Tract Changes at Birth

Greig¹,

Young²,

Azmy³

1991

Eur J Pediatr Surg

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The aim of this study was to assess 2 groups of children with spina bifida; one with and the other without upper renal tract (URT) changes at birth and to evaluate the outcome of their management. In Group 1, there were 148 patients who had normal URT at birth. They were studied for a mean follow-up of 131 months. Twenty-eight per cent developed URT changes in later life. The median time interval for URT changes to develop between birth and the first assessment which showed abnormal finding, was 33 months and between the last normal URT assessment and the development of URT changes, was 16 months. Six patients with URT changes were treated conservatively and 36 required intervention. Twenty-eight of 42 patients showed initial improvement of URT changes but 25 subsequently deteriorated. In 3 patients renal function deteriorated with renal failure in one and renal impairment in 2. In Group 2, 24 patients who had URT changes present at birth were also studied for a mean follow-up of 115 months. The URT changes in 8 patients deteriorated after the initial assessment over a median time of 15 months. Twelve patients' URT changes improved spontaneously without active intervention over a median time interval of 16 months but 5 subsequently deteriorated. Overall, the prognosis of children with URT changes at birth did not seem to be any worse than children developing changes later in life. Lesions of sacral and thoraco-lumbar regions of the spine were most commonly associated with URT changes.(ABSTRACT TRUNCATED AT 250 WORDS)

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The Upper Renal Tracts in Adolescents and Young Adults with Myelomeningocele

Cited by 3 publications

References 1 publication

Évaluation du suivi urologique à l’âge adulte des spina bifida avec une myéloméningocèle

Évaluation du suivi urologique à l’âge adulte des spina bifida avec une myéloméningocèle

Has Vesicostomy a Role in the Neuropathic Bladder?

Follow-Up of Spina Bifida Children with and without Upper Renal Tract Changes at Birth

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