ABSTRACT
PURPOSE: We evaluated the risk factors for upper urinary tract deterioration in children with neurogenic bladder. MATERIALS AND METHODS: The study population consisted of 60 children (36 boys, 24 girls) with neurogenic bladder confirmed by urodynamic study between January 1994 and June 2007. The average follow-up period was 48 months. The patients' medical records were assessed concerning gender, presence of vesicoureteral reflux (VUR), hydronephrosis, type of spinal dysraphism, level of spinal dysraphism, practice of clean intermittent catheterization (CIC), type of neurogenic bladder, bladder capacity, compliance, detrusor sphincter dyssynergia, recurrent urinary tract infection (UTI), and timing of primary neurosurgical repair. Upper urinary tract deterioration was diagnosed by 99m technetium-dimercaptosuccinic acid renal scan (DMSA) and aggravation of hydronephrosis and VUR. RESULTS: Upper urinary tract deterioration was detected in 15 patients (25%). Hydronephrosis, VUR, and UTI were associated with upper urinary tract deterioration in the univariate analyses. In the multivariate analyses, hydronephrosis [odds ratio (OR)=2.181, 95% confidence interval (CI)=1.191-11.941, p=0.036] and recurrent UTI [OR=5.810, 95% CI=1.200-28.192, p=0.029] were independent risk factors for upper urinary tract deterioration. CONCLUSIONS: Hydronephrosis and recurrent UTI increase the risk of upper urinary tract deterioration in children and adolescents with neurogenic bladder. Therefore, intensive observation and prompt intervention may be recommended for such cases.
Subject(s)
Adolescent , Child , Humans , Ataxia , Compliance , Follow-Up Studies , Hydronephrosis , Intermittent Urethral Catheterization , Medical Records , Multivariate Analysis , Risk Factors , Spinal Dysraphism , Urinary Bladder , Urinary Bladder, Neurogenic , Urinary Tract , Urinary Tract Infections , Urodynamics , Vesico-Ureteral RefluxABSTRACT
In the surgery of central area, identifying the motor cortex in front of central sulcus is imperative to prevent loss of motor function. Twenty five patients with tumors or intractable epilepsy near the central sulcus were operated on at the Department of Neurosurgery of Chonbuk National University Hospital, from September. 1991 to December 1993. An estimated localization of lesions was performed with Callosal Grid System, which is a methodolgy made available by the development of high quality of magnetic resonance imaging, digital subtraction angiography and high resolution computerized tomography. This system allowed us to be oriented to the motor cortex as well as permitted assessment of the extent of resection. This was further delineated by direct electrical stimulation, which confirmed the functional motor cortex and made it possible to maximized the tumor resection near and in the motor cortex. The combination of direct cortical stimulation(functional mapping) and the use of the Callosal Grid System(anatomical mapping) allowed us to identify the spatial relationship between them as well as to maximize the tumor resection in most cases without injury to the central area, so that the better outcome is guaranted.
Subject(s)
Humans , Angiography, Digital Subtraction , Brain Neoplasms , Electric Stimulation , Epilepsy , Magnetic Resonance Imaging , Motor Cortex , NeurosurgeryABSTRACT
No abstract available.