A Study of neurogenic bladder in children managed by both conservative line and surgery.

Vinay, - (2010) A Study of neurogenic bladder in children managed by both conservative line and surgery. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND : Neurogenic bladder sphincter dysfunction (NBSD) can develop as a result of a lesion at any level in the nervous system, including the cerebral cortex, spinal cord, or peripheral nervous system. Neurologic conditions in children leading to neurogenic bladder dysfunction are predominantly congenital neural tube defects (including myelomeningocele, lipomeningocele, sacral agenesis, and occult lesions causing tethered cord). Acquired causes such as spinal cord tumors or trauma or sequelae of transverse myelitis are less frequent. Whereas from an etiologic standpoint neurogenic bladder dysfunction is a heterogeneous group, medical management will be similar irrespective of the underlying cause. MATERIALS AND METHODS : This is a retrospective analysis of all children with neurogenic bladder admitted in Department of Paediatric Surgery, Christian Medical college ,Vellore during 2003 to 2008.The operative data and follow up data were collected from their hospital charts. PATIENTS : A total of 194 patients were admitted between January 2003 to December 2008 with neurogenic bladder. 131 patients came for follow up and their follow up data is available. Mean follow up period was 3.08 years(Range 1year to 16 years). RESULTS : Children were grouped into two categories based on their management .One group consisted of children managed with conservative line and other group constituted children managed with surgery. A total of 128 (65.9%) children were managed conservatively, only 76 children came for follow up. A total of 66 children were managed by surgery and 57 children came for follow up. Most common etiology being meningomyelocele constituting 122 (62.8%) childrens. Most patients presented with serum creatinine less than 1mg%,only 18 children (1%)presented with serum creatinine above 1 mg%. 92 (48.1%) patients presented with normal preserved upper tracts and 68(35%) of patients presented with moderate to gross hydro‐ureteronephrosis.31(16%) patients had mild hydronephrosis. There were total of 116 (33.3%) refluxing ureters.Of which 41(11.8%) were minor refluxing ureters and 75 (21.5%) were major refluxing ureters. Bladder trabeculation in cystourethrogram was found in 144 (82.7%) children. Conservative (medical) management : patients were managed with CIC and oxybutynin. A total of 128 (65.9%) patents were managed with CIC & oxybutynin. 76 patients came for follow up.7 children were irregular in their CIC who were readmitted and importance of CIC was reinforced.69 children were regular and compliant in their CIC and were dry in between CIC. Surgery : A total of 66 (34.1%) patients underwent surgical procedure for management of neurogenic bladder. Most common surgery was augmentation cystoplasty using bowel done in 47 patients Ureteric reimplant with appendicular Mitrofanoff done in 12 patients,Vesicostomy or Ureterostomy done in 7 patients. CONCLUSION : Medical management with CIC and anticholinergics is effective in preserving renal function and providing safe urinary continence in more than 90% of patients with a neurogenic bladder. Early diagnosis and treatment institution, long before continence becomes an issue at toddler age, can prevent both renal damage and secondary bladder-wall changes, thereby improving long-term outcomes. Augmentation cystoplasty is indicated where conservative line of management has failed.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neurogenic bladder ; management ; follow up ; Descriptive study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 01 Aug 2017 03:18
Last Modified: 01 Aug 2017 08:23
URI: http://repository-tnmgrmu.ac.in/id/eprint/2407

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