What is the utility of urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunction? ICI-RS 2017

2018 ◽  
Vol 37 (S4) ◽  
pp. S25-S31 ◽  
Author(s):  
Angie Rantell ◽  
Yutao Lu ◽  
Marcio A. Averbeck ◽  
Jasmin K. Badawi ◽  
Kevin Rademakers ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Tract Damage ◽  
Lower Urinary

scholarly journals Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

2017 ◽  
Vol 53 (02) ◽  
pp. 090-096
Author(s):  
Rahul Saxena ◽  
Arvind Sinha ◽  
Manish Pathak ◽  
Avinash S Jadhav ◽  
Ankur Bansal
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Asymptomatic Children ◽  
Determine Role ◽  
Urinary Tract Symptoms ◽  
Tract Damage ◽  
Lower Urinary

ABSTRACT Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage. Aim: To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM. Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure. Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1). Conclusion: Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage.

scholarly journals Neurogenic Bladder: Epidemiology, Diagnosis, and Management

2020 ◽  
Vol 40 (05) ◽  
pp. 569-579
Author(s):  
Jalesh N. Panicker
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Renal Ultrasound ◽  
Preliminary Evaluation ◽  
Cord Injury ◽  
Tailored Approach ◽  
Tract Damage ◽  
Lower Urinary

AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.

Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis

2016 ◽  
Vol 22 (11) ◽  
pp. 1490-1494 ◽  
Author(s):  
Jeroen R Scheepe ◽  
Yu Yi M Wong ◽  
E Daniëlle van Pelt ◽  
Immy A Ketelslegers ◽  
Coriene E Catsman-Berrevoets ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Early Disease ◽  
High Prevalence ◽  
Potential Damage ◽  
Urinary Problems ◽  
Lower Urinary

Neurogenic lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) is highly prevalent in adults, but has not previously been described in paediatric MS. A total of 24 consecutive children with newly diagnosed MS were prospectively assessed for bladder and bowel problems early after diagnosis. Five of 24 children (21%) showed LUTD during assessment. One of these patients did not report voiding complaints. This high prevalence of LUTD indicates that all recently diagnosed patients with paediatric MS should be evaluated early in their disease and treated for urinary problems in order to prevent potential damage to the upper urinary tract.

Clinical Update: Spinal Cord Impairments

2000 ◽  
Vol 5 (1) ◽  
pp. 5-6
Author(s):  
Lorne K. Direnfeld
Keyword(s):  
Spinal Cord ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Bladder Dysfunction ◽  
Cauda Equina ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Urodynamic Evaluation ◽  
Cord Injury ◽  
Lower Urinary

Abstract Lower urinary tract dysfunction may result from a variety of neurologic disorders, including traumatic spinal cord injury, head injury, a cauda equina syndrome, or trauma to the peripheral lumbosacral nerves. Urinary incontinence can be divided into five categories: stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, and total incontinence. A table lists each type, provides a description, and gives both common and neurological examples. Evaluation of voiding dysfunction should not be based on symptoms alone, and urodynamic evaluation is required also. Indeed, urodynamic evaluation is the only means to establish a functional interrelationship of the components of the lower urinary tract. Most ratings of neurogenic bladder dysfunction are performed using Section 4.3d, Urinary Bladder Dysfunction, and Table 17, Criteria for Neurologic Impairment of the Bladder in the AMA Guides to the Evaluation of Permanent Impairment. Ratings for whole-person permanent impairment depend on symptomatology (ie, urgency, dribbling, or incontinence), voluntary control, and bladder reflex activity. If problems with urinary system dysfunction are related to a combination of neurologic and urologic pathology, including pathology in the upper urinary tract, ratings from both sections can be combined using the Combined Values Chart.

scholarly journals Recent Advances in Urinary Tract Reconstruction for Neuropathic Bladder in Children

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 204 ◽  
Author(s):  
Roberto I. Lopes ◽  
Armando Lorenzo
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Reconstructive Procedures ◽  
Neuropathic Bladder ◽  
Urinary Tract Reconstruction ◽  
Tract Infections ◽  
Tract Damage ◽  
Lower Urinary

Neuropathic bladder usually causes several limitations to patients’ quality of life, including urinary incontinence, recurrent urinary tract infections, and upper urinary tract damage. Its management has significantly changed over the last few years. The aim of our paper is to address some salient features of recent literature dealing with reconstructive procedures in pediatric and adolescent patients with lower urinary tract dysfunction.

scholarly journals The Current Positioning of Augmentation Enterocystoplasty in the Treatment for Neurogenic Bladder

2020 ◽  
Vol 24 (3) ◽  
pp. 200-210 ◽  
Author(s):  
Seong Jin Jeong ◽  
Seung-June Oh
Keyword(s):  
Quality Of Life ◽  
Urinary Tract ◽  
Surgical Procedure ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Augmentation Enterocystoplasty ◽  
Lower Urinary

Augmentation enterocystoplasty (AEC) is a surgical procedure in which the bladder is enlarged using an intestinal segment in patients with lower urinary tract dysfunction who fail to achieve satisfactory results with all conservative treatments. Currently, surgical materials and procedures, concomitant correction of upper urinary tract abnormalities, or bladder neck reconstruction may vary depending on the experience and preferences of the surgeons. AEC has been proven to be successful with respect to surgical goals, such as achieving urinary continence, improving quality of life, and preserving the upper urinary tract over the long term. The advantage of AEC over intravesical injection of botulinum toxin—a more recent and less invasive procedure—is that the prevention of upper urinary tract damage and the improvement of urinary incontinence are more reliably guaranteed, especially considering that these surgical effects are permanent. Compared to less invasive treatments, the quality of life of patients after surgery is also much higher, and AEC may be more cost-effective in the long run. Thus, in patients with neurogenic bladder, AEC is still the gold standard surgical procedure with strong evidence in support of its efficacy. In this article, the indications, surgical methods, possible complications, long-term follow-up, and current positioning of AEC in lower urinary tract dysfunction is discussed.

scholarly journals A neurogén húgyhólyag klinikuma és terápiás lehetőségei

2021 ◽  
Vol 162 (4) ◽  
pp. 135-143
Author(s):  
Péter Járomi ◽  
Tamás Banyó ◽  
Mihály Boros ◽  
Ferenc Papp ◽  
Andrea Szabó
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Autonomic Dysreflexia ◽  
Bladder Pressure ◽  
Lower Urinary Tract Dysfunction ◽  
Detrusor Contractility ◽  
Wide Range ◽  
Lower Urinary

Összefoglaló. Az alsó húgyutak fő funkciója a vizelet tárolása és ürítése, amely működések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függően vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felső húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertőzésekre és kőképződésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fő csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képező neurogén hólyag egy gyűjtőfogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycső is érintett, ezt a kórképet napjainkban „neurogén alsó húgyúti diszfunkció” elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felső és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltérő etiológia ellenére a klinikai tünetek rendszerint két alapvető klinikai típusban manifesztálódhatnak: túlműködő (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulműködő hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövő felső húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segítő algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felső húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135–143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the “bladder outlet”) affected, nowadays this condition is referred to as “neurogenic lower urinary tract dysfunction”. A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135–143.

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