Neurogenic Bladder Research Articles

Urethral keratosis caused by vitamin A deficiency: two case reports

BackgroundDysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD.Case presentationAn 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot’s spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings.ConclusionDysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism.

Neuroborreliosis Presenting as Urinary Retention: Case Report.

Lyme disease is a tick-borne infectious disease caused by the spirochete Borrelia burgdorferi. Voiding dysfunction is a rare manifestation of neuroborreliosis with only a few cases reported. Here we describe a case of a 6-year-old male child with an acute urinary retention, paraparesis, and voiding difficulty in whom neuroborreliosis was diagnosed through serologic tests for antibodies, Western blot testing confirmation and intrathecal antibody synthesis. Magnetic resonance imaging (MRI) of the spine led to the diagnosis of acute transverse myelitis and a urodynamic study demonstrated detrusor areflexia. He received a 4-week course of intravenous ceftriaxone (2 g/d). The patient has recovered from the paraparesis but still suffers from a neurogenic bladder.

Meta-analysis of the curative effect of sacral nerve magnetic stimulation on neurogenic bladder after spinal cord injury.

The curative effect of sacral nerve magnetic stimulation on the neurogenic bladder (NB) after spinal cord injury (SCI) is unclear. This study made a meta-analysis of the curative effect of sacral nerve magnetic stimulation on the NB after SCI and put forward a theoretical basis for the clinical treatment of this disease. The databases of PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, VIP, and CBM were searched by computer, and the randomized controlled trials of sacral nerve magnetic stimulation in the treatment of NB after SCI were collected. The retrieval time was from the establishment of the database to September 25, 2023. Meta-analysis was performed with Stata 15.0 software. This study finally included 10 articles, including 537 patients. Meta-analysis shows that the sacral nerve magnetic stimulation treatment group can effectively improve urodynamics: the maximum bladder capacity increases (mean difference [MD], 40.76 [95% confidence interval (CI), 33.24-48.28]; P ˂ .05), the bladder capacity increases at the beginning of urination (MD, 12.82 [95% CI, 11.02-14.62]; P ˂ .05), and the residual urine volume decreases (MD, -38.08 [95% CI, -51.36 to -24.79]; P˂.05). In the aspect of urination diary, the sacral nerve magnetic stimulation treatment group also has advantages compared with the conventional treatment group: the increase in single urine volume (MD, 22.49 [95% CI, 18.68-26.30]; P˂.05), the maximum urine volume (MD, 32.84 [95% CI, 22.37-43.30]; P˂.05), and the decrease in urination times (MD, -2.23 [95% CI, -3.13 to -1.33]; P˂.05). After the treatment of sacral nerve magnetic stimulation, the quality of life of patients can be improved: quality-of-life score (MD, -0.62 [95% CI, -0.91 to -0.34]; P˂.05). Combined with functional magnetic stimulation of the sacral nerve, routine treatment is superior to routine treatment in improving the clinical symptoms of patients with NB after SCI.

Is body composition important in the context of renal function in pediatric neurogenic bladder?

Neurogenic bladder due to myelomeningocele (MMC) is a significant risk factor for chronic kidney disease in children. Cystatin C (CysC) is a more accurate GFR marker than creatinine as it is unaffected by muscle mass but may be influenced by fat mass and BMI. This study evaluates: (1) GFR measurement accuracy using CysC and creatinine in MMC-related neurogenic bladder, (2) the relationship between body composition via bioelectrical impedance analysis (BIA) and renal parameters, and (3) the use of BIA for non-invasive GFR and body composition assessment. Forty children (median age 9.96years) underwent serum creatinine, CysC testing, and BIA measurements. We assessed age, sex, spinal lesion level, anthropometric measurements, BMI, and activity using Hoffer's scale. GFR was calculated using five creatinine-based formulas, three CysC-based, and three combining CysC and creatinine, including BIA GFR as an alternative approach. Creatinine-based GFR estimates were significantly higher than CysC-based GFR. Although only 30% of MMC patients met the traditional BMI criteria for overweight/obesity, 62.5% were obese based on BIA-measured body fat percentage. Significant differences were found in CysC and CysC-based GFR equations within BMI and fat mass groups. Positive correlations were observed between CysC and body weight, BMI percentiles, body fat mass and fat-to-muscle ratio. Muscle mass positively correlated with creatinine. BIA-determined fat mass percentage is a more sensitive obesity indicator than BMI in MMC patients. CysC levels and CysC-based GFR equations are influenced by body fat mass, requiring consideration of adiposity to avoid misestimating renal impairment.

A tissue bandage for pelvic ganglia injury

Neurogenic bladder often occurs after pelvic ganglia injury. Its symptoms, like severe urinary retention and incontinence, have a significant impact on individuals’ quality of life. Unfortunately, there are currently no effective treatments available for this type of injury. Here, we designed a fiber-enhanced tissue bandage for injured pelvic ganglia. Tight junctions formed in tissue bandages create a mini tissue structure that enhances resistance in an in vivo environment and delivers growth factors to support the healing of ganglia. Strength fibers are similar to clinical bandages and guarantee ease of handling. Furthermore, tissue bandages can be stored at low temperatures over 5 months without compromising cell viability, meeting the requirements for clinical products. A tissue bandage was applied to a male rat with a bilateral major pelvic ganglia crush injury. Compared to the severe neurogenic bladder symptoms observed in the injury and scaffold groups, tissue bandages significantly improved bladder function. We found that tissue bandage increases resistance to mechanical injury by boosting the expression of cytoskeletal proteins within the major pelvic ganglia. Overall, tissue bandages show promise as a practical therapeutic approach for ganglia repair, offering hope for developing more effective treatments for this thorny condition.

Endoscopic correction of vesicoureteral reflux after chemodenervation of the detrusor with botulinum toxin in a child with a neurogenic bladder and myelodysplasia. Case report

Correction of vesicoureteral reflux in children with neurogenic bladder (NB) and myelodysplasia is rather challenging due to the presence of two aggravating factors. The first is the trabecularity of the bladder due to chronic ischemia and dysfunction of the closing contraction of the ureteral orifice up to complete deconfiguration of the ureterovesical junction, and the second is the neurogenic hyperactivity of the detrusor with hypertonicity, intravesical hypertension, and a significant decrease in the effective volume of the bladder. These pathophysiological mechanisms reduce to zero the effectiveness of open reimplantation of the ureter to create an anti-reflux mechanism, becoming, on the contrary, the cause of reflux aggravation and the development of ureterohydronephrosis. As a result, the correction of reflux in NB becomes impossible without stabilization of detrusor contractility, elimination of intravesical hypertension, and correction of spastic changes in the bladder. Clinical follow-up of a patient with this disorder for 10 years convincingly proves the effectiveness of step-by-step correction of NB and vesicoureteral reflux while adhering to the order of treatment methods.

Intrathecal baclofen obviating the need for bladder stimulator use in a patient with secondary dystonia: illustrative case.

Children with cerebral palsy often have neurogenic bladders. Bladder function is further affected by complex medical management and multifactorial disease processes, leading to worsened function and poorer quality of life. Intrathecal baclofen (ITB) therapy has been used to treat hypertonia and spasticity, but implications in neurogenic bladder management have not been well described. A 20-year-old female with a history of cerebral palsy and neurogenic bladder treated with sacral neuromodulation underwent ITB therapy and subsequently experienced improvement in bladder control, obviating the need for bladder stimulator use. ITB improves hypertonia and can effectively obviate the need for neurostimulation to treat neurogenic bladder in patients with cerebral palsy. Further research is necessary to discern mechanisms. https://thejns.org/doi/10.3171/CASE24364.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

The relationship between urodynamic bladder compliance and urinary fibrosis markers in children with neurogenic bladder dysfunction

BackgroundDecreased bladder compliance is an important risk factor for upper urinary tract in children with neurogenic bladder dysfunction (NBD). Urodynamics is the gold standard in determining bladder compliance. ObjectiveTo investigate the relationship between low bladder compliance and urinary fibrosis markers in NBD. Study designSpina bifida patients with NBD, who admitted between March 2021 and July 2021 were included. Patients with low compliant bladders, no renal scar, no recurrent urinary tract infections formed low compliance, LC group. Normal compliance, NC group, was comprised of patients with normocompliant bladders and the same characteristics. Control group (Group C) consisted of patients for outpatient surgery and had no known bladder dysfunction. Compliance was calculated with the formula ΔV/ΔP and a value of under 15 ml/cmH2O was accepted as low. Age, gender, urine density, serum urea, creatinine levels and urodynamic parameters were noted. Urinary type 1, type 3 collagen and its precursor procollagen type 3 and serum type 1 and 3 collagen were determined by ELISA. Results72 patients were included (LC group, n:31, NC group, n:24, C group n:17, mean age 7,39±1,24 years). No significant difference was observed in the comparison of age, gender, urine density and serum urea and creatinine values. No significant difference was observed between the LC and NC groups for urodynamic parameters, except for bladder compliance. Urinary collagen type 1 in LC group (11,71±3,02 ng/ml) was found to be significantly higher than that of the C group (9,45±1,97 ng/ml) (p=0,03). Urinary procollagen type 3 was significantly higher in LC group (103,15±24 ng/ml) when compared to C group (82,42±22,26 ng/ml) (p=0,016). Urinary collagen type 1 level above 9,20 ng/ml was 80,6% sensitive and 70,6% specific and urinary procollagen type 3 level above 78 ng/ml was 87% sensitive and 70,6% specific in predicting low compliance. DiscussionThis study seems to be the first study in the literature to evaluate bladder fibrosis and compliance, biochemically, by measuring urinary collagen levels in NBD. Urinary fibrosis markers are not currently an alternative to urodynamics for bladder compliance, but they may have potential to reduce the need for urodynamics with this indication. ConclusionDetermination of urinary collagen levels may be a marker of bladder wall fibrosis and may indirectly show decreased bladder compliance. It is plausible to say that invasive methods such as urodynamics may be less preferred for defining bladder compliance, instead, urinary biomarkers may have merit for this purpose in the future.

Particularities of spasticity in myelomeningocele patients.

Myelomeningocele (MMC), a congenital neural tube defect, is the most common developmental anomaly of the central nervous system (CNS). Spasticity is among the main disabling factors in these patients, affecting up to 1/5 of children. The purpose of this article is to review the current knowledge regarding spasticity in MMC patients, mainly focusing on its manifestations and management. A literature search was conducted using the PubMed database for the terms "myelomeningocele" and "spasticity." Data were collected by 5 independent investigators and then synthesized in a scoping format. Causes of spasticity in these patients include hydrocephalus, tethered cord syndrome (TCS), syringomyelia, CNS infection, and associated congenital brain and spine anomalies. Clinical manifestations include limb spasticity and neurogenic bladder. Spasticity primarily affects muscles below the neurological level and contributes to gait impairment. Besides walking ability, spasticity also severely affects functional mobility in general, self-care, and quality of life. The majority of MMC patients experience neurogenic bladder. Treatment of spasticity can be symptomatic or target its cause. Medical and surgical options are available for both limb and bladder spasticity. Regular physiotherapy and orthotics are used to prevent contractures and the early introduction of orthoses is the cornerstone of a gait training program. Neurosurgical treatment options for spasticity include nonablative and ablative procedures such as selective dorsal rhizototmy. The urodynamic pattern guides treatment strategies, with intermittent catheterization being the best treatment option for patients with underactive detrusor and overactive sphincter muscles. Given the particularities of spasticity in MMC patients, a multidisciplinary team approach and early rehabilitation programs are keys for their optimal management.

Avoiding sliding doors: small changes, big difference in multiple sclerosis and neurogenic bladder and bowel

The aim of this article is to illustrate the experienced and optimal patient journeys of people with multiple sclerosis. A review of research published in the British Journal of Neuroscience Nursing in 2024 was conducted to build on the insights and provide guidance around each part of the patient journey, from diagnosis to care. A composite patient journey was created based on the experiences of the MS patients interviewed as part of the ALERT study. Many people with multiple sclerosis experience delayed diagnosis and management of bladder and bowel dysfunction, leading to significant physical and psychosocial consequences. The composite patient journey showed common clinical touchpoints where care was sub-optimal. There was a lack of early discussions about bladder and bowel issues, insufficient patient education and missed opportunities for intervention. Early diagnosis, patient education and integrated care pathways are essential for managing neurogenic bladder and bowel dysfunction in people with multiple sclerosis. By addressing these issues proactively, healthcare providers can improve patient outcomes and quality of life. Policy initiatives should focus on increasing awareness, education and developing clinical guidelines to support effective bladder and bowel management. Integration of care services reduces inequities and improves wellbeing.

Expression of Wnt signaling proteins in rare congenital bladder disorders

Introduction and AimsCongenital bladder anomalies are rare and are a leading cause of end stage renal failure in children. The Wnt signaling pathway, important during embryonic development, has been implicated in the pathogenesis of these conditions through regulation of gene expression, including essential transcription factors. We investigated the expression of four Wnt transcriptional targets, namely, Pygopus 1 (Pygo1), FRA1, TCF7L1 and Connexin 43 (Cx43) in three rare congenital bladder disorders: bladder exstrophy (BE), neurogenic bladder (NGB) and posterior urethral valves (PUV). MethodsBladder tissue samples were collected from patients at the Great Ormond Street Hospital for Sick Children, London, UK, with control (normally-functioning bladder, N=9), BE (N=15), NGB (N=6) and PUV (N=5). Histological analysis was performed using the van Gieson stain to differentiate smooth muscle (SM) and connective tissue (CT) compartments. An unbiased, automated, semi-quantitative immunofluorescence analysis was performed to measure the labelling intensity of four Wnt-related proteins in tissue from these four groups. Results and DiscussionThere was a significant (p<0.05) increase in the expression of Pygo1 in the smooth muscle of all anomalies examined and also in the connective tissue in PUV compared to control. Cx43 also showed overexpression in the smooth muscle across all conditions; however, there was a reduced expression in NGB and an increase in PUV in connective tissue. TCF7L1 showed a significant decrease in both tissue compartments for NGB, whereas FRA1 expression remained unchanged across all anomalies. We also measured colocalization of Wnt-related proteins. TCF7L1 exhibited increased colocalization with Pygo1 and FRA1 in exstrophy compared to control. These results suggest a complex dysregulation of the Wnt pathway in congenital bladder disorders. ConclusionWnt signaling-related proteins show dysregulation in congenital bladder disorders compared to control tissue. Understanding these mechanisms should help towards non-invasive early diagnosis, drug target discovery and development of treatment strategies for these conditions.Summary tableSummary of Wnt-related protein expression and colocalization in bladder exstrophy (BE), neurogenic bladder (NGB) and posterior urethral valves (PUV) disorder compared to normally-functioning control bladder. The table shows the levels of expression as significantly up (↑) down (↓) or no change (-) of Pygopus 1 (Pygo1), Connexin 43 (Cx43), FRA1 and TCF7L1 expression in smooth muscle and connective tissue compartments in BE, NGB and PUV relative to control bladder tissue samples. The table also shows colocalization of six protein pairs of Pygo1 and FRA1; Pygo1 and Cx43; Pygo1 and TCF7L1; FRA1 and Cx43; FRA1 and TCF7L1 and Cx43 and TCF7L1 in bladder disorders compared to control.Summary tableProtein Expression (Smooth muscle)Pygo1Cx43FRA1TCF7L1BE↑↑--NGB↑↑-↓PUV↑↑--Protein Expression (Connective tissue)BE----NGB-↓-↓PUV↑↑--ColocalizationPygo1/FRA1Pygo1/Cx43Pygo1/TCF7L1FRA1/Cx43FRA1/TCF7L1Cx43/TCF7L1Exstrophy--↑-↑-NGB------PUV------

Atypical Acute Myeloid Leukemia Presentation: Spinal Metastasis and Neurogenic Bladder

Atypical Acute Myeloid Leukemia Presentation: Spinal Metastasis and Neurogenic Bladder

316 - Course of pregnancies and deliveries in 9 women operated on for congenital and post-traumatic neurogenic bladder and intestinal dysfunction.

316 - Course of pregnancies and deliveries in 9 women operated on for congenital and post-traumatic neurogenic bladder and intestinal dysfunction.

The integral co-management role of the medical pediatric urologist: Improving the care of children with urological conditions

The complexities of modern medicine prompt a re-evaluation of traditional patient care models to enhance safety and quality. We implemented a one-year pilot Medical Pediatric Urology fellowship, jointly developed by Urology and Pediatric Hospital Medicine, where a pediatrician received postgraduate training in both specialties. This innovative program aimed to augment knowledge and expertise in non-surgical aspects of pediatric urology. Upon completion of the fellowship, the trained pediatrician assumed the role of medical pediatric urologist (MPU), integrating into both Pediatrics and Urology faculties. Unlike the traditional specialist consultation model, the MPU became integral member of the Urology Division, working full-time and sharing responsibilities for both inpatient and outpatient pediatric urology care at a tertiary pediatric hospital in Canada. This study aims to delineate the training curriculum, role, clinical outcomes, and educational impact of the MPU over eight years. We retrospectively analyzed clinical outcomes, including patient volumes seen annually by MPU, urologists, and nurse practitioners from 2021 to 2023. Clinic wait times and patient satisfaction were compared between MPU's community and tertiary hospital pediatric urology clinics. Educational impact was assessed through pediatric residents' ratings for the MPU as a clinical teacher during urology rotations using a Likert scale. Integration of MPU led to the establishment of specialized clinics, including those for neurogenic bladder and posterior urethral valves. MPU accounted for approximately 34.7% of all outpatient clinic visits. Subjective feedback highlighted enhanced quality of care with MPU co-management in the inpatient setting. Additionally, in a community-based medical urology clinic (CUC) staffed by the MPU and a pediatric urology nurse practitioner, patients experienced shorter wait times and higher satisfaction (53±36 days and 194±108 days) (p<0.01), with 97% vs. 91% of families reported feeling highly satisfied with care (p<0.01) compared with hospital clinics, respectively. The MPU received ratings of 4/5 or 5/5 as a clinical teacher from 81.82% of pediatric residents. Our novel co-management approach in pediatric urology integrates medical and surgical expertise. However, limitations include the retrospective design and single-center setting. Nonetheless, this framework presents a potential model for other surgical specialties, offering a unique practice niche for trainees interested in the medical management of surgical conditions. The medical pediatric urologist plays a pivotal role as an educator, hospitalist, and director of the outpatient clinic, effectively integrating medical and surgical expertise. The MPU model is promising for optimizing safety and quality of care in pediatric urology.

Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal cancer surgery

BackgroundPostoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass.MethodsWe included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions.ResultsOf the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of < 158 cm, age ≥ 70 years, surgery lasting ≥ 8 h, intraoperative bleeding volume ≥ 150 mL, lateral lymph node dissection, and narrower pelvis. It was more prevalent in cases with low VFA. Conversely, gender, body mass index (BMI), and medical history showed no significant correlations. Multivariate analysis revealed older age, prolonged surgery, and low VFA as independent risk factors for PONB. Independent risk factors for severe PONB included low VFA, older age, prolonged surgery, and deep pelvis.ConclusionLower VFA, older age, and prolonged surgery are independent risk factors for developing PONB. Additionally, a deep pelvis is an independent risk factor for severe PONB. Delicate surgical techniques should consider the risk of nerve injury in cases with low VFA and deep pelvis.

Botulinum Neurotoxin Type A in paediatric non-neurogenic therapy resistant overactive bladder: a cohort study.

Intradetrusor Botulinum Neurotoxin Type A (BoNT-A) is an increasingly applied treatment modality for overactive bladder (OAB) in children with refractory urinary incontinence. Despite that, evidence is sparse, and the potential not fully understood. The aim of this study was to evaluate the effectiveness and safety of intradetrusor injection in children with refractory functional OAB and urinary incontinence. Furthermore, we aimed to identify predictors of efficacy and side effects to BoNT-A treatment. We conducted a cohort study of children with OAB and urinary incontinence who received intradetrusor injection of BoNT-A in the period 01.01.2016 to 31.12.2020 at our centre. All patients were refractory to standard urotherapy, anticholinergics, mirabegron and the combination of these treatments. Patients with neurogenic bladder were excluded. Primary endpoint was the reduction on the frequency of urinary incontinence episodes from baseline. Secondary endpoints included urodynamic parameters and uroflowmetry characteristics as well as side effects. Forty-three children (mean age at first treatment 10.7 ± 1.8, 30 males) were included. After first treatment, a reduction of ≥ 50% in incontinence episodes was seen in 58% of patients with daytime urinary incontinence (DUI) and 47% of patients with nocturnal enuresis (NE). Adverse events, mainly urinary tract infections (UTI), were reported by 16% of patients after first treatment. Our analysis identified normal cystometric compliance as a significant predictor of treatment effect We estimated the mean duration of effect to be approximately 7months. Intradetrusor BoNT-A injection appears to be a safe and effective option in treating refractory urinary incontinent children with overactive bladder. We identified cystometric compliance as a predictor of response. Most children necessitate repeated treatments. Further prospective and controlled studies are necessary in order to fully identify predictors and potential of treatment.

Assessment of quality of life in patients with neurogenic bladders who undergone urinary system reconstruction (Mitrofanoff)

Assessment of quality of life in patients with neurogenic bladders who undergone urinary system reconstruction (Mitrofanoff)

Preventive Effects of Gonadotropin-Releasing Hormone Treatment on Urinary Bladder and Kidney Damage in Spinal Cord Injured Rats.

One of the main causes of a neurogenic bladder is spinal cord injury (SCI),(SCI), which induces little or no bladder reflex activity. Because of this alteration, there is an increased risk of developing urinary tract infections and kidney damage. Gonadotropin-releasing hormone (GnRH) treatment has been shown to improve micturition in a rat model of SCI. The present study was aimed at determining whether GnRH administration is capable to reduce bladder and kidney damage in rats with SCI. Ovariectomized female Wistar rats were divided into three groups: sham, SCI with saline solution (SCI), and SCI treated with GnRH (SCI+GnRH) for 6 weeks. SCI was induced by compression at the T10 spinal level. At the end of the experiment, bladders and kidneys were processed for morphological and immunofluorescence analysis. For morphometric analysis, the thickness of the urothelium and the muscular layer of the bladder was measured, as well as the intensity of staining related to collagen in the kidney. At the end of the experiment, all animals in the sham group showed normal urination (100%), in contrast, the percentage of untreated injured rats (SCI) that did not require manual stimulation for micturition was 19%, while the treated group (SCI+GnRH) was 68%. A significative increase in bladder weight, urothelial and muscle thickness, and collagen-related coloration in the kidney was observed in SCI when compared to sham rats. GnRH administration decreased damage to the urinary bladder and kidneys after SCI in rats. These results suggest that this hormone could be a potential preventive treatment for SCI patients at risk of neurogenic bladder and kidney damage. Not applicable.

Success Rate and Predicting Factors for Repeated High-Dose Intradetrusor Dysport Injections in Children With Neurogenic Bladder: A Retrospective Study.

Evaluating the effectiveness and safety of repeated high-dose intradetrusor abobotulinumtoxin A (Dysport®) injections for the treatment of pediatric neurogenic bladders refractory to medications. Retrospective interventional study. The cohort included 37 children (22 boys and 15 girls) of median age 9.2 years. Inclusion criteria were diagnosis of neurogenic bladder and failure to respond to medical treatment. Exclusion criteria were augmented bladder, insufficient data, and interval of > 11 months between video-urodynamic study and Dysport injection. All participants were treated with an intra-detrusor injection of Dysport 30 IU/kg (up to 1000 IU) under general anesthesia. Repeated (second and third) injections were scheduled (6-12 months) in patients who demonstrated an improvement in cystometric parameters. All participants underwent video urodynamic testing before onset of treatment and 4-5 months after subsequent injection. Success of treatment was defined as a decrease in end filling pressure (EFP) to < 40 cm H2O and/or a 20% increase in maximal cystometric capacity (MCC). These parameters along with initial bladder features were evaluated for ability to predict treatment success. No side effects of Dysport were observed or reported. The overall success rate was 62%. MCC increased by a median of 30% (IQR 200-300, p < 0.001), 37% (IQR 197-310, p = 0.001) and 45% (IQR 245-300, p = 0.025) after the first, second and third injections, respectively. Median EFP decreased from 45 cm H2O to 34 cm H2O (IQR 20-45, p = 0.029), 23 cm H2O (IQR 20-37, p = 0.004), and 20 cm H2O (IQR 12-32, p = 0.049) after the first, second, and third injections, respectively. No predicting factor of success of treatment were found; However, three of five cases of "end stage" bladder showed improvement. High-dose Dysport injection is safe and effective for the treatment of neurogenic bladder. Studies with larger cohort and a control group would further elucidate which bladders would benefit most. At present, we recommend treating also bladders with "end stage" features with botulinum toxin before considering augmentation.