Pseudotail with closed neural tube defect and neurogenic bladder masquerading as posterior urethral valve: a case report

Abstract Background Pseudotail with occult spinal dysraphism with neurological deficit is a rare phenomenon. Ignoring pseudotail as sign of occult spinal dysraphism may lead to catastrophe in diagnosis and further management. Case presentation We are reporting a case of a 30-month-old male child who presented with a tail-like structure at lower back and dribbling of urine since birth. On initial evaluation at some other hospital, he was misdiagnosed as posterior urethral valve and underwent fulguration of valve. However, dribbling of urine persisted after initial procedure. On evaluation at our center, he was found to have pseudotail with occult spinal dysraphism and neurogenic bladder. Conclusion Pseudotail with occult spinal dysraphism with neurological deficit is a rare phenomenon. Neurogenic bladder in such case can be misdiagnosed as posterior urethral valve. So, neurogenic bladder with pseudotail should be evaluated cautiously to avoid misdiagnosis and mismanagement.

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SECOND-TRIMESTER ULTRASONOGRAPHIC DIAGNOSIS OF SEGMENTAL VERTEBRAL ABNORMALITIES ASSOCIATED WITH NEUROLOGICAL DEFICIT: A POSSIBLE NEW VARIANT OF OCCULT SPINAL DYSRAPHISM

Prenatal Diagnosis ◽

10.1002/(sici)1097-0223(199608)16:8<760::aid-pd940>3.0.co;2-t ◽

1996 ◽

Vol 16 (8) ◽

pp. 760-763 ◽

Cited By ~ 8

Author(s):

REUWEN ACHIRON ◽

SHLOMO LIPITZ ◽

DAN GRISARU ◽

MARGALIT RANAN ◽

JACOB BAR-ZIV ◽

...

Keyword(s):

Neurological Deficit ◽

Spinal Dysraphism ◽

Second Trimester ◽

Occult Spinal Dysraphism ◽

Ultrasonographic Diagnosis ◽

New Variant

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Sacral Dysgenesis Associated with Occult Spinal Dysraphism Causing Neurogenic Bladder Dysfunction

The Journal of Urology ◽

10.1016/s0022-5347(17)58370-6 ◽

1977 ◽

Vol 117 (1) ◽

pp. 127-128 ◽

Cited By ~ 8

Author(s):

David Cumes

Keyword(s):

Neurogenic Bladder ◽

Bladder Dysfunction ◽

Spinal Dysraphism ◽

Neurogenic Bladder Dysfunction ◽

Occult Spinal Dysraphism

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Effects of electrotherapy in treatment of neurogenic bladder in children with occult spinal dysraphism

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0910502c ◽

2009 ◽

Vol 137 (9-10) ◽

pp. 502-505 ◽

Cited By ~ 1

Author(s):

Dragana Cirovic ◽

Ivana Petronic ◽

Dejan Nikolic ◽

Radivoj Brdar ◽

Polina Pavicevic ◽

...

Keyword(s):

Spina Bifida ◽

Neurogenic Bladder ◽

Combined Therapy ◽

Statistical Significance ◽

Spinal Dysraphism ◽

Bladder Capacity ◽

Occult Spinal Dysraphism ◽

Enuresis Nocturna ◽

Transcutaneous Electric Nerve Stimulation ◽

Urodynamic Parameters

Introduction Neurogenic bladder can develop as a result of various degrees of neurogenic lesion in spina bifida. The degree of bladder dysfunction depends on the level and type of spina bifida. Due to results upon complete diagnostic protocols, treatment options are applied. Objective Comparison of therapy results of patients with occult spinal dysraphism with neurogenic bladder that under-went medicamentous therapy and medicamentous with electrotherapy treatment. Methods We had 49 patients with neurogenic bladder that were treated at the University Children's Hospital in Belgrade in the period 2003-2008. The first group of children received medicamentous therapy and the second group received medicamentous therapy with transcutaneous electric nerve stimulation. In both groups we evaluated 4 symptoms: daily enuresis, enuresis nocturna, urgency and frequency and 4 urodynamic parameters: lower bladder capacity, unstable contractions and residual urine and detrusor sphincter dyssynergia. Follow-up urodynamic evaluation was done after 3, 6 and 12 months respectively. Results Our findings pointed out a high statistical significance of improvement in all evaluated urodynamic parameters of neurogenic bladder (predominantly in bladder capacity) in the group of children with combined therapy as well in resolution of symptoms (predominantly enuresis nocturna, urgency and frequency). Conclusion Combined therapy is more efficient in treatment of children with neurogenic bladder. Electrotherapy is non-invasive, easily applicable and has had a significant place in treatment of children with dysfunctional voiding.

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Clinical and Radiological Changes after use of Alpha-1 Blocker Therapy in Patients of Posterior Urethral Valve with Bladder Neck Hypertrophy

JMS SKIMS ◽

10.33883/jms.v12i1.7 ◽

2009 ◽

Vol 12 (1) ◽

pp. 3-7

Author(s):

Aejaz A Baba ◽

Bajpai Minu

Keyword(s):

Bladder Neck ◽

Posterior Urethral Valve ◽

Posterior Urethral Valves ◽

Blocker Therapy ◽

Urethral Valve ◽

Novel Method ◽

Radiological Changes ◽

Group 2 ◽

Mean Time ◽

Group 1

Background: We evaluated the effects of alpha-1 blocker therapy on clinical and radiological abnormalities in patients of posterior urethral valve with bladder neck hypertrophy. Materials and Methods: A total of 74 patients with posterior urethral valves were seen at our department between 2003 and 2007. Out of these 24 had radiological evidence of bladder neck hypertrophy. Those patients with bladder neck hypertrophy who were seen before June 2006 and did not receive alpha-1 blocker (prazocin) therapy after valve ablation were assigned to group 1 (n=10). Group 2 consisted of 14 age matched patients with bladder neck hypertrophy and comparable prognostic factors who received alpha-1 blocker therapy after valve ablation (n=14). Micturating cystourethrography (MCU) was done periodically and a novel method used to calculate bladder neck hypertrophy. Trends in symptoms and radiological changes were evaluated throughout follow-up. Results: Mean patient age at presentation was 3.02±2.68 years in group 1 and 3.12±3.4 years in group 2. Bladder neck hypertrophy decreased from 2.3±1.0 to 2.0±0.5 in a mean time of 52.0 (34-52) weeks in group 1 where as it decreased from 2.2±0.5 to 1.6±0.3 in a mean time of 32.0 (22-52) weeks. Symptomatically patients in group 2 who received alpha-1 blocker therapy after valve ablation were better and had quick resolution of bladder neck hypertrophy. Conclusions: Use of alpha-1 blocker therapy in patients of posterior urethral valve with bladder neck hypertrophy helps in quick resolution of bladder neck hypertrophy. J Med Sci 2009;12(1):3-7.

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Posterior Urethral Valve a Correlation between Role of Ultrasound and Micturating Cystourethrogram.

International Journal of Scientific Research ◽

10.15373/22778179/dec2013/186 ◽

2012 ◽

Vol 2 (12) ◽

pp. 18-20

Author(s):

DR. HARDIK BRAHMBHATT ◽

◽

Dr. Viplav Gandhi ◽

Dr. Gurudatt Thakkar

Keyword(s):

Posterior Urethral Valve ◽

Micturating Cystourethrogram ◽

Urethral Valve

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Outcome of posterior urethral valve in 64 children: a single center's 22-year experience

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.19.03272-7 ◽

2019 ◽

Vol 71 (6) ◽

Cited By ~ 1

Author(s):

Mehtap Ezel Çelakil ◽

Zelal Ekinci ◽

Burcu Bozkaya Yücel ◽

Nazım Mutlu ◽

Ayla Günlemez ◽

...

Keyword(s):

Posterior Urethral Valve ◽

Urethral Valve

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Congenital Dermal Sinus Elements in Each Tethering Stalk of Coexisting Thoracic Limited Dorsal Myeloschisis and Retained Medullary Cord

Pediatric Neurosurgery ◽

10.1159/000511876 ◽

2020 ◽

pp. 1-8

Author(s):

Takato Morioka ◽

Nobuya Murakami ◽

Masako Ichiyama ◽

Takeshi Kusuda ◽

Satoshi O. Suzuki

Keyword(s):

Present Article ◽

Dermoid Cyst ◽

Spinal Dysraphism ◽

Conus Medullaris ◽

Dermal Sinus ◽

Case Presentation ◽

Upper Tract ◽

Secondary Neurulation ◽

Extradural Space ◽

Congenital Dermal Sinus

Introduction: The embryogenesis of limited dorsal myeloschisis (LDM) likely involves impaired disjunction between the cutaneous and neural ectoderms during primary neurulation. Because LDM and congenital dermal sinus (CDS) have a shared origin in this regard, CDS elements can be found in the LDM stalk. Retained medullary cord (RMC) is a closed spinal dysraphism involving a robust, elongated, cord-like structure extending from the conus medullaris to the dural cul-de-sac. Because the RMC is assumed to be caused by impaired secondary neurulation, concurrent RMC and CDS cannot be explained embryologically. In the present article, we report a case in which CDS elements were noted in each tethering stalk of a coexisting LDM and RMC. Case Presentation: A 2.5-month-old boy with left clubfoot and frequent urinary and fecal leakage had 2 tethering tracts. The upper tract, which ran from the thoracic tail-like cutaneous appendage, had CDS elements in the extradural stalk and a tiny dermoid cyst in the intradural stalk immediately after the dural entry. In the lower tract, which ran from the lumbosacral dimple, the CDS as an extradural stalk continued to the RMC at the dural cul-de-sac. Both stalks were entirely resected through skip laminotomy/laminectomy at 1 stage to untether the cord and resect the CDS elements. Conclusion: Surgeons should be aware that CDS elements, in addition to LDM, may coexist with RMC that extends out to the extradural space.

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Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

Pediatric Neurosurgery ◽

10.1159/000511091 ◽

2021 ◽

pp. 1-7

Author(s):

Rajeev Sharma ◽

Swati Mahajan ◽

Minakshi Bhardwaj ◽

Laxmi Naraian Gupta ◽

Deepak Gupta

Keyword(s):

Surgical Planning ◽

English Literature ◽

Spinal Dysraphism ◽

Neurenteric Cyst ◽

Germ Layers ◽

Case Presentation ◽

Spinal Lesions ◽

Congenital Origin ◽

Thoracic Spinal ◽

Intradural Extramedullary

Introduction: Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. Case presentation: We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. Conclusion: Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

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