Currarino Syndrome: lower urinary tract function, treatment plan and outcomes

Currarino syndrome (CS) is a rare congenital disorder characterized by anorectal malformation, sacral agenesis and presacral mass. We performed video-urodynamics (VUDS) assessment of patients with CS to characterize the lower urinary tract function, individualize management plans and to follow outcomes. We conducted a cross-sectional study on 11 patients diagnosed with CS at the spina bifida multidisciplinary clinic. Lower urinary tract function was assessed by VUDS from three months to 12 months after neurosurgery. All patients had sacral agenesis; nine patients had anorectal malformation (9/11, 81.8%) and five patients had a presacral mass (5/11, 45.5%). The average age at neurosurgery was 7.9 months (range, 2–19). One patient had bilateral vesicoureteral reflux (VUR) with increasing detrusor pressure at the end of filling. In two patients, the detrusor activity showed weakening during urination, while no other lower urinary tract abnormality was identified on urodynamic evaluation. Six patients underwent VUDS before and after surgery; of these, two patients showed improved bladder function after surgery, while the remaining four patients showed no change in urodynamics. The average duration of follow-up was 27.5 months (range, 9–51). Renal function was normal in all patients. We can conclude that patients with CS often exhibit associated neurological abnormalities. VUDS assessment may help detect lower urinary tract dysfunction at an early stage and facilitate timely urological intervention to avoid kidney damage.

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Intrathecal Opioids and Lower Urinary Tract Function

Anesthesiology ◽

10.1097/00000542-200406000-00023 ◽

2004 ◽

Vol 100 (6) ◽

pp. 1497-1503 ◽

Cited By ~ 49

Author(s):

Peter W. Kuipers ◽

Ed T. Kamphuis ◽

Ger E. van Venrooij ◽

John P. van Roy ◽

Traian I. Ionescu ◽

...

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract ◽

Intrathecal Administration ◽

Lower Urinary Tract Dysfunction ◽

Flow Measurements ◽

Detrusor Contractility ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Dose Dependent ◽

Lower Urinary

Background Intrathecal administration of opioids may cause lower urinary tract dysfunction. In this study, the authors compared the effects of morphine and sufentanil administered intrathecally in a randomized double-blind fashion (two doses each) on lower urinary tract function in healthy male volunteers. Methods Urodynamic evaluation was performed before and every hour after drug administration up to complete recovery of lower urinary tract function using pressure and flow measurements recorded from catheters in the bladder and rectum. Sense of urge and urinary flow rates were assessed every hour by filling the bladder with its cystometric capacity and asking the patient to void. Full recovery was defined as a residual volume of less than 10% of bladder capacity and a maximum flow rate within 10% of the initial value. Results Intrathecal administration of both opioids caused dose-dependent suppression of detrusor contractility and decreased sensation of urge. Mean times to recovery of normal lower urinary tract function were 5 and 8 h after 10 or 30 microg sufentanil and 14 and 20 h after 0.1 or 0.3 mg morphine, respectively. This recovery profile can be explained by the spinal pharmacokinetics of both opioids. Conclusions Intrathecal opioids decrease bladder function by causing dose-dependent suppression of detrusor contractility and decreased sensation of urge. Recovery of normal lower urinary tract function is significantly faster after intrathecal sufentanil than after morphine, and the recovery time is clearly dose dependent.

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Longitudinal Study of Lower Urinary Tract Function in Children with Anorectal Malformation

European Journal of Pediatric Surgery ◽

10.1055/s-0033-1357299 ◽

2013 ◽

Vol 24 (06) ◽

pp. 492-499 ◽

Cited By ~ 3

Author(s):

Helena Borg ◽

Gundela Holmdahl ◽

Monica Doroszkievicz ◽

Ulla Sillen

Keyword(s):

Longitudinal Study ◽

Urinary Tract ◽

Anorectal Malformation ◽

Lower Urinary Tract ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Lower Urinary

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Recent advances in urodynamics in women

F1000Research ◽

10.12688/f1000research.24640.1 ◽

2020 ◽

Vol 9 ◽

pp. 606

Author(s):

Georgina Baines ◽

Ana Sofia Da Silva ◽

George Araklitis ◽

Dudley Robinson ◽

Linda Cardozo

Keyword(s):

Urinary Tract ◽

Health Care Professionals ◽

Lower Urinary Tract ◽

Lower Urinary Tract Dysfunction ◽

Invasive Treatment ◽

Technological Advances ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Ambulatory Urodynamics ◽

Lower Urinary

Urodynamics is the study of the storage and evacuation of urine from the urinary tract. The aim is to reproduce the patient’s symptoms and provide a pathophysiological explanation for them by identifying all factors that contribute to the lower urinary tract dysfunction, including those that are asymptomatic. Urodynamics consists of various tests, each of which is designed to assess a different aspect of lower urinary tract function. There is a lack of evidence regarding when urodynamics should be used in the non-neurogenic bladder. Some small randomised controlled trials suggest that urodynamics does not alter the outcome of surgery for stress urinary incontinence when compared with office evaluation alone. However, this is widely felt to be inaccurate and many health-care professionals still advocate the use of urodynamics prior to any invasive treatment, especially surgery on the lower urinary tract. There have been few technological advances in urodynamics in recent years. Air-charged rather than fluid-filled catheters were thought to help reduce artefact, but the evidence is unclear, and there is doubt over their accuracy. Ambulatory urodynamics is carried out over a longer period of time, enabling physiological bladder filling, but it remains invasive and artificial. To attempt to replicate symptoms more accurately, there have been efforts to develop wireless devices to measure detrusor pressure directly. These may be promising but are far from suitable in humans at present. Urodynamics continues to provide useful information for assessing lower urinary tract function, but further large studies are required to assess its value and develop innovations to improve the accuracy of the tests and acceptability to patients.

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Neuromodulation for Lower Urinary Tract Dysfunction – An Update

The Scientific World JOURNAL ◽

10.1100/tsw.2007.173 ◽

2007 ◽

Vol 7 ◽

pp. 1036-1045 ◽

Cited By ~ 14

Author(s):

Zahid Hussain ◽

Simon C. W. Harrison

Keyword(s):

Urinary Tract ◽

Nerve Stimulation ◽

Sacral Nerve Stimulation ◽

Lower Urinary Tract ◽

Therapeutic Option ◽

Lower Urinary Tract Dysfunction ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Voiding Difficulties ◽

Lower Urinary

The aim of this review is to provide an update on the use of neuromodulation using sacral nerve stimulation for the treatment of disorders of the lower urinary tract. Neuromodulation using the InterStim® system (Medtronic Inc.) is now accepted as an established therapeutic option for patients with detrusor overactivity, and for women with retention or severe voiding difficulties. However, the use of nerve stimulation in modulating lower urinary tract function has to be regarded as a technique that is in its infancy. Much has yet to be learned about the mechanism by which neuromodulation exerts its effects and there is a need to better define the clinical indications for the treatment. There is also work to be done in terms of optimising stimulation delivery, both in anatomical and electronic terms.

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