Update on Urological Management of Spina Bifida from Prenatal Diagnosis to Adulthood

Snow-Lisy, Devon C.; Yerkes, Elizabeth B.; Cheng, Earl Y.

doi:10.1016/j.juro.2015.03.107

Cited by 137 publications

(104 citation statements)

References 42 publications

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“…This illustrates that while individuals with intellectual disability may lag in initiating ISC, their cognitive ability alone should not preclude them from being taught these skills. Though controversy exists concerning the indications for commencement of clean intermittent catheterization and treatment with anticholinergic medications [23], once underway a case can be made for a proactive approach to ISC. Given the improved longevity of individuals with SB, transitional care issues (such as health-related independence) are becoming progressively more vital.…”

Section: Discussionmentioning

confidence: 99%

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

Castillo

Ostermaier

Fremion

et al. 2017

PRM

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Abstract. PURPOSE:To describe the age of independence in intermittent self-catheterization (ISC) in a diverse patient population and identify factors associated with ISC in individuals with spina bifida. METHODS: Two hundred patients with myelomeningocele or lipomyelomeningocele, who were 3 years of age and utilized catheterization for bladder management were included. Data regarding diagnosis, functional level of lesion, race, ethnicity, presence of shunt, method of catheterization, self-management skills, fine motor skills, and cognitive abilities were collected. RESULTS: Fifty-five percent of individuals were able to perform ISC with a mean age of 9.45 years (SD = 2.97) and 22.7% used a surgically created channel. Higher level of lesion and female gender were associated with a lower rate of ISC. Intellectual disability was present in 15% of the individuals able to perform ISC and in 40% of those not able to perform ISC (p = 0.0005). Existent self-efficacy regarding activities of daily living (i.e. dressing, bathing, skin care) were associated with ISC (p < 0.0001). CONCLUSIONS: The average age of ISC emerged as a target for culturally-appropriate educational interventions to stimulate greater early independence. Future research on factors that may foster an 'independent spirit' early in childhood leading to self-management are warranted.

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Section: Discussionmentioning

confidence: 99%

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

Castillo

Ostermaier

Fremion

et al. 2017

PRM

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“…The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care. 2 Birth of a baby born with MMC and hydrocephalus brings with it a lot of stress to parents. As for parents, it is equally difficult for treating paediatric surgeon to achieve satisfactory outcome in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…• Pre-operative broad-spectrum antibiotic, 2 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth.…”

Section: Protocol Of Our Spina Bifida Clinicmentioning

confidence: 99%

Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country

et al. 2017

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Background: Meningomyelocele (MMC) and meningocele (MC) are the two most common types of neural tube defects (NTD) seen. Some of the problems associated with care of these patients are psychological stress is parents, average financial condition of caretakers, ignorance on the part of parents, local physicians for management of this condition, very few dedicated Spina bifida clinics and social stigma associated with this condition. The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care involving paediatric surgeon, paediatrician, nursing staff, occupational therapist, physiotherapist, social worker, parents and patients themselves. The aim of this study is to discuss our experience in initial management of meningomyelocele (MMC) and hydrocephalus and long-term management of bladder/bowel incontinence and foot deformity in a tertiary care hospital of a developing country. Methods: A retrospective nonrandomized observational study was conducted in the department of pediatric surgery at a tertiary hospital, from August 2008 to October 2015. Overall 145 patients of meningomyelocele were included in the study. Patients were managed according to our institution protocol. Results: 68.2% MMC patients were repaired primarily. 24.1% of total patients needed Y-V plasty skin advancement flap. 7.5% patients needed synthetic patch for dural closure. 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth. 5.5% patients were incontinent after MMC repair. 8.2% patients had decreased lower limb power after MMC repair. 28.9% patients needed VP shunt for gross hydrocephalus before MMC repair. 51.03% patients needed VP shunt after MMC repair. 20% patients did not require VP shunt in the present series. 13.1% patients in the present series had urinary incontinence. 11.03% patients had fecal incontinence. 73.6% patients with urinary incontinence were successfully managed with conservative treatment. 87.5% patients with fecal incontinence responded to conservative treatment. Bladder augmentation was done in 26.3% of neurogenic bladder dysfunction patients. 60% of these patients had dry interval of more than 4 hours. MACE was done in 12.5% of neurogenic bowel dysfunction patients. 2 patients required simultaneous bladder augmentation, Mitrofanoff's and MACE procedure. One of these patients achieved a dry interval of >4 hour. Conclusions: Successful rehabilitation of children with MMC can be achieved with parental education and support, dedicated clinicians, trained nursing staff, regular follow-up and low threshold for diagnosing clinical deterioration and proactive management to prevent further clinical deterioration.

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“…13 Expectant management involves regular monitoring with clinical assessment and ultrasound and the introduction of CIC, urodynamics, or anticholinergics if deterioration occurs. Although proponents argue that the early detection of upper tract changes results in reversibility, it may result in a higher rate of bladder augmentation.…”

Section: Neonatal and Infantmentioning

confidence: 99%

“…There has also been concern regarding death from malignancy after bladder augmentation, which is reported to be 0-5%, 13,32 and is likely highest when gastric segments are used. 14,33 However, it is unclear whether an augmentation increases this risk or if it is the nature of the neuropathic bladder Neuropathic bladders (i.e., exstrophy, immune suppression after transplant, smoking, infection, catheterization, chronic UTIs, and bladder stones).…”

Section: Elementary Schoolmentioning

confidence: 99%

Neuropathic bladders: Investigation and treatment through their lifetime

Metcalfe¹

2017

CUAJ

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The child with a neuropathic bladder requires lifelong dedicated care. Just as each patient presents with unique physiology, each phase of their life presents varying challenges. The primary concern for our patients is their renal health, but continence and independence also play significant roles. Most patients can be managed conservatively, but a myriad of surgical options are also available, reinforcing our emphasis on individualized care. Appropriate presurgical planning is required to ensure the right patient receives the best operation for his/her wants and needs. Furthermore, the numerous potential complications must be understood and longterm followup and surveillance is required.This review outlines the basic pathophysiology, investigations, and treatments, with a focus on the changing needs throughout their lives.

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Update on Urological Management of Spina Bifida from Prenatal Diagnosis to Adulthood

Cited by 137 publications

References 42 publications

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country

Neuropathic bladders: Investigation and treatment through their lifetime

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