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

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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Occult Spinal Dysraphism: A Challenge in Pain Management

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e225 ◽

2015 ◽

Vol 2;18 (2;3) ◽

pp. E225-E228

Author(s):

Frederic J Gerges

Keyword(s):

Pain Management ◽

Spina Bifida ◽

Spinal Dysraphism ◽

Lumbar Radiculopathy ◽

Occult Spinal Dysraphism ◽

Case Scenario ◽

Vascular Abnormalities ◽

The Central Nervous System ◽

Radicular Symptoms ◽

Clinical Dilemma

Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms. Key words: Occult spinal dysraphism, spina bifida, lumbar radiculopathy, pain, pain management, physical findings

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Occult spinal dysraphia - a case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh04s1111r ◽

2004 ◽

Vol 132 (suppl. 1) ◽

pp. 111-114 ◽

Cited By ~ 2

Author(s):

Mirjana Raicevic ◽

Dusan Abramovic ◽

Miljan Mihajlovic ◽

Ivana Petronic ◽

Marko Vidosavljevic

Keyword(s):

Diabetes Mellitus ◽

Spina Bifida ◽

Spinal Dysraphism ◽

Occult Spinal Dysraphism ◽

Skin Changes ◽

Previous Pregnancy ◽

X Ray ◽

Female Children ◽

Neurosurgical Treatment

One of the most complex and most difficult congenital anomalies is spina bifida. Peter Van Forest was the first one who noticed this anomaly in 1587, and Recklinghausen, in 1886, classified spina bifida to types and suggested surgical procedures for its management. Earlier name, spina bifida, is currently more and more replacing with a term ?defect of neural tube? (NTDs), or even more, ?spinal dysraphia?. Anomaly can appear at any level of spinal cord (cervical, thoracal, lumbar and sacral) and posterior localization is more often than the anterior one. Contrary to the open spinal dysraphism that can be perceived immediately, closed spinal dysraphism is very deceiving anomaly, and therefore, it must be treated properly as soon as it is diagnosed. Because of its seclusion, the term usually used is ?occult spinal dysraphism (OSD)?. The incidence of this anomaly is unknown, but it has been reported that it is more common among female children. Etiology of OSD is also unknown, but some of its risk factors are as follows: previous pregnancy with NTD, partner with NTD, type 1 diabetes mellitus, usage of anticonvulsives, a lack of folates in mother?s nutrition. Prenatal diagnose of OSD is practically impossible. Skin changes, orthopedic, urological and neurological problems, suggest considering this complex anomaly. X-ray, ECHO, MRI, as well as neuropsychological examination corroborate diagnosis. At the same time, the diagnosis (once it is confirmed) represents the indication for neurosurgical treatment.

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The Mermaid Malformation: Cloacal Exstrophy and Occult Spinal Dysraphism

Neurosurgery ◽

10.1227/00006123-199106000-00008 ◽

1991 ◽

Vol 28 (6) ◽

pp. 834-843 ◽

Cited By ~ 48

Author(s):

Alan R. Cohen

Keyword(s):

Spina Bifida ◽

Spinal Dysraphism ◽

Radiographic Examination ◽

Developmental Defect ◽

Pathological Anatomy ◽

Occult Spinal Dysraphism ◽

Cloacal Exstrophy ◽

Neurological Evaluation ◽

Terminal Myelocystocele

Abstract Five infants with cloacal exstrophy underwent neurological evaluation and radiographic examination of the caudal spine shortly after birth. Each was found to have occult spinal dysraphism. Four had terminal myelocystoceles, and one had a lipomyelomeningocele. Pathological anatomy was confirmed during surgery for the release of the tethered spinal cords. The striking association between cloacal exstrophy and occult spinal dysraphism suggests a common developmental defect in the caudal pole of the embryo. A hypothesis is offered to explain this association. Terminal myelocystocele and lipomyelomeningocele appear to be part of a continuum of lesions associated with skin-covered spina bifida.

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Botulinum Toxin Injection for Medically Refractory Neurogenic Bladder in Children: A Systematic Review

Toxins ◽

10.3390/toxins13070447 ◽

2021 ◽

Vol 13 (7) ◽

pp. 447

Author(s):

Shu-Yu Wu ◽

Shang-Jen Chang ◽

Stephen Shei-Dei Yang ◽

Chun-Kai Hsu

Keyword(s):

Systematic Review ◽

Botulinum Toxin ◽

Neurogenic Bladder ◽

Botulinum Toxin A ◽

Botulinum Toxin Injection ◽

Previous Treatment ◽

Bladder Capacity ◽

Minimal Risk ◽

Efficacy Evaluation ◽

Urodynamic Parameters

The objective was to evaluate the use of botulinum toxin A (BTX-A) injection in children with medically refractory neurogenic bladder. A systematic review of the literature was conducted using three databases (Medline via PubMed, Cochrane, and EMBASE). Articles evaluating BTX-A in children with neurogenic bladder were collected. The clinical and urodynamic parameters were reviewed for the safety and efficacy evaluation. Sixteen studies were selected into this study and a total of 455 children with medical refractory neurogenic bladder were evaluated. All of the patients had received traditional conservative medications such as antimuscarinics and intermittent catheterization as previous treatment. The duration of treatments ranged from 2 months to 5.7 years. Improvements in incontinence and vesicoureteral reflux were the most common clinical outcomes. The detrusor pressure, bladder capacity and bladder compliance improvement were the most common urodynamic parameters which had been reported. However, patient satisfaction with the procedure remained controversial. There was only a minimal risk of minor adverse effects. In all of the studies, BTX-A injection was well tolerated. In conclusion, BTX-A injection appears to be a safe and effective treatment in the management of medically unresponsive neurogenic bladder in children. There is currently no evidence that the use of BTX-A injection could be used as a first-line therapy for neurogenic bladder in children.

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

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00104-9 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ram Jeewan Singh ◽

Md Mokarram Ali ◽

Amit Kumar ◽

Rashi Rashi ◽

Amit Kumar Sinha ◽

...

Keyword(s):

Neurogenic Bladder ◽

Neurological Deficit ◽

Spinal Dysraphism ◽

Posterior Urethral Valve ◽

Occult Spinal Dysraphism ◽

Case Presentation ◽

Lower Back ◽

Rare Phenomenon ◽

Initial Procedure ◽

Urethral Valve

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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