Evaluación del proceso de atención urológica de pacientes pediátricos con mielomeningocele / Evaluation of the urological care process of pediatric patients with myelomeningocele

Introducción: El mielomeningocele (MMC) es una de las malformaciones congénitas más severas compatible con la vida. El 90% de los pacientes presenta vejiga neurogénica que debe ser evaluada y tratada precozmente. Objetivos: Describir la evaluación y tratamiento nefrourológico recibido por pacientes con MMC hasta el momento de la primera consulta en el Hospital Garrahan (periodo pre-ingreso). Describir la evaluación realizada y el tratamiento urológico implementado a partir del ingreso al hospital Garrahan (periodo post-ingreso). Evaluar la prevalencia de Enfermedad Renal Crónica (ERC). Población y Métodos: Se realizó un estudio con diseño clínico analítico, retrospectivo, longitudinal sobre pacientes con MMC de 1 mes a 18 años derivados al Hospital Garrahan para atención ambulatoria en los años 2011 y 2012. Resultados: Se incluyeron115 pacientes. Al momento de la derivación al hospital ("pre-ingreso") 7% de los pacientes habían logrado completar evaluación nefrourológica, (ecografía vesicorenal, urodinamia, Cistouretrografía, Centellograma renal y Creatininemia). Tratamiento: 33% vaciaban vejiga por CIL o vesicostomía y 21% recibían Oxibutinina. A partir del ingreso al seguimiento en el Garrahan 83% lograron completar la evaluación, y en función del resultado de la misma se indicó CIL en 87% y Oxibutinina en el 66% de los pacientes. La prevalencia de ERC al ingreso fue de 43%; la mayoría en estadio I. Conclusiones: La mayoría de los pacientes con MMC fueron derivados al hospital de tercer nivel con evaluaciones urológicas incompletas y sin el tratamiento adecuado de la vejiga neurogénica. El inicio del seguimiento interdisciplinario en un hospital de alta complejidad facilitó la realización de las evaluaciones necesarias y la implementación del tratamiento adecuado (AU)

Introduction: Myelomeningocele (MMC) is one of the most severe congenital malformations compatible with life. Of all the patients, 90% presents with a neurogenic bladder requiring early evaluation and treatment. Objectives: To describe the uronephrological evaluation and treatment received by patients with MMC up to the first consultation at Garrahan Hospital (pre-follow-up period). To describe the urological evaluation and treatment implemented from referral to Garrahan Hospital (follow-up period). To evaluate the prevalence of chronic kidney disease (CKD). Population and Methods: A retrospective, longitudinal study with a clinical, analytical design was conducted in patients with MMC between 1 months and 18 years of age referred to Garrahan Hospital for outpatient care in 2011 and 2012. Results: 115 patients were included. At the time of referral to the hospital ("pre-follow-up") 7% of the patients had undergone complete uronephrological evaluation (kidney-bladder ultrasonography, urodynamic studies, cystourethrography, renal scintigraphy, and creatininemia levels). Treatment: 33% emptied their bladder by CIC or vesicostomy and 21% received oxybutynin. From follow-up initiation at Garrahan Hospital, 83% underwent complete evaluation, and based on the results CIC was indicated in 87% and oxybutynin in 66% of the patients. On admission, prevalence of CKD was 43%; with stage I in the majority of the patients. Conclusions: The majority of the patients with MMC were referred to a third-level hospital with incomplete urological studies and without adequate treatment of the neurogenic bladder. Initiation of interdisciplinary follow-up at a tertiary hospital allowed for the necessary studies and implementation of adequate treatment (AU)

Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for brazilian portuguese

ABSTRACT Objective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian Portuguese, in patients with spinal cord injury and multiple sclerosis. Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p <0.0001). Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.

Indicaciones de estudio urodinámico / Indications of urodynamic study

The basic objective of urodynamics is to reproduce the patient's symptoms while evaluating the lower urinary tract directly, with objective quantification of parameters, correlating the symptoms with the findings of the test. Traditionally, it is used: a) to diagnose lower urinary tract dysfunction, quantify its severity and determine the most significant abnormality, b) to predict the consequences of lower urinary tract dysfunction on the upper urinary tract, c) to predict the results of therapeutic interventions and possible complications and d) to investigate the causes of treatment failures. In this article we will refer to the indications of urodynamics taking into account the recommendations of the main international urological societies: 1) in women with urinary incontinence, with emphasis on those who have stress urinary incontinence and who will undergo surgery, 2) in men with non-neurogenic lower urinary tract symptoms suggestive of benign prostatic hyperplasia, and 3) in patients with neurologic involvement of the lower urinary tract ("neurogenic bladder"), considering the classification of neurological disorders according to the risk over the upper urinary tract. (AU)

Rol de onabotulinumtoxin A en el tratamiento de niños con vejiga neurogénica / The rol of Onabotulinumtoxin A in the treatment of children with a neurogenic bladder

Introducción: Onabotulinumtoxina es una alternativa terapéutica de segunda línea en pacientes sin respuesta a los anticolinérgicos. Objetivo: Evaluar los efectos de repetidas inyecciones de onabotulinumtoxina en vejigas neurogénicas refractarias al tratamiento clásico. Pacientes y métodos: Se evaluaron 82 pacientes menores de 18 años con vejiga neurogénica, en su mayoría por disrafia espinal. Todos fueron refractarios a oxibutinina oral. Si luego del tercer mes de la primer inyección en el detrusor se constataba mejoría clínica y/o urodinámica; se reinyectaban entre los 9 y 12 meses, nuevamente. De lo contrario, se indicaba cistoplastia de aumento. En algunos casos se utilizaron otros procedimientos endoscópicos - quirúrgicos accesorios. Resultados: Se reinyectaron con Onabotulinumtoxina, dos, tres, cuatro y cinco veces: 20 casos, 7, 4 y un caso, respectivamente. En el 51% promedio se logró continencia urinaria total (score cero-seco). En la primera y segunda inyección hubo incremento significativo en la media de capacidad cistométrica: de 254 a 331 ml (p: 0.007) y de 257 a 367 ml (p: 0.014); respectivamente. En algunos casos, luego de la primer inyección mejoró significativamente la compliance: de 6,9 a 11,4 ml/cmH2O (p: 0.05). La media de presión del detrusor al final del llenado disminuyó en promedio de 37 a 34,4 cmH2O. La sobreactividad del detrusor (n:22) se atenuó en el 54,4% luego de la primer inyección. No se registraron efectos adversos mayores con las reinyecciones. En 15 pacientes refractarios a OnabotulinumtoxinA se realizó ampliación vesical. Conclusión: Luego del tratamiento con onabotulinumtoxina, la continencia urinaria alcanzada fue del 50% promedio. La capacidad cistometrica se incrementó significativamente con las dos primeras inyecciones; aunque no se acompañó paralelamente de un importante descenso de presiones endovesicales. El uso de onabotulinumtoxina ha logrado suprimir o retrasar la clásica indicación de cistoplastia de aumento en niños refractarios a los anticolinérgicos (AU)

Introduction: OnabotulinumtoxinA is a second-line alternative therapy for patients who do not respond to anticholinergics. Aim: To evaluate the impact of repeated injections of OnabotulinumtoxinA in neurogenic bladders refractory to conventional treatment. Patients and methods: 82 patients younger than 18 years with a neurogenic bladder, in the majority due to spinal dysraphism, were evaluated. All were refractory to oral oxybutynin. If in the third month after the first injection in the detrusor clinical and/or urodynamic improvement was observed, between 9 and 12 months later a second injection was given. If not, augmentation cystoplasty was indicated. In some cases other endoscopic/surgical procedures were used. Results: Twenty, seven, four, and one case were reinjected with OnabotulinumtoxinA, two, three, four, and five times, respectively. In a mean of 51% of the patients total urinary continence was achieved (score zero - completely dry). On the first and second injection a significant increase of the maximum cystometric capacity was observed: from 254 to 331 ml (p: 0.007) and from 257 to 367 ml (p: 0.014), respectively. In some cases, after the first injection compliance improved significantly: from 6.9 to 11.4 ml/cmH2O (p: 0.05). Mean end filling detrusor pressure diminished from 37 to 34.4 cmH2O. Detrusor overactivity (n: 22) attenuated in 54.4% after the first injection. No major adverse effects were recorded after the reinjections. In 15 patients that were refractory to OnabotulinumtoxinA augmentation cystoplasty was performed. Conclusion: After OnabotulinumtoxinA treatment, 50% urinary continence was achieved. Cystometric capacity increased significantly after the first two injections; however, it was not associated with an important decrease of intravesical pressure. The use of OnabotulinumtoxinA may avoid or delay the classical indication of augmentation cystoplasty in anticholinergicrefractory children (AU)

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications / Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.

Paruresis / Paruresis

Paciente masculino de 36 años de edad, profesional universitario, casado en primeras nupcias, con dos hijos. Refiere dificultad para orinar en presencia de otras personas, “desde siempre”, pero actualmente le crea problemas, pues por el trabajo que ha desempeñado en los últimos 3 años tiene que viajar con relativa frecuencia. Plantea que es una persona sana, sin padecimientos psíquicos; maneja el estrés de forma satisfactoria y su situación económica la considera favorable. Previamente se estudió por urología. Se brinda información sobre la afección y se establece una estrategia de exposición in vivo, con la cooperación de la esposa y empleo de urinarios públicos para la práctica y exploración de avances. Luego de 6 meses de seguimiento y con discretos progresos, deja de asistir a consulta; regresa aproximadamente un año después, plantea que se siente mejor y la mayor parte de las veces logra efectuar la micción. Se espera a partir de la presentación de este caso, motivar a otros autores a estudiar y publicar sus hallazgos sobre esta afección en Cuba. Es la primera vez que en los años de práctica del autor como psiquiatra, un paciente le solicita ayuda por esta causa.

A 36 year-old male patient (college graduate, married his first wife, has two children) referred to always have difficulty at urinating in the presence of others, but currently this is a problem because he has to business travel quite often during in the last three years. He argues that he is healthy with no mental illnesses; he manages stress successfully and he considers having favorable economic situation. Previously he was studied at the urology service. Information about this condition is offered, and a strategy of in vivo exposure is established with the cooperation of his wife and using public urinals to practice and exploration progress. After 6 months follow-up and modest progress, he failed to attend consultation. He returned about a year later, he suggested that felt better and most of the time he achieved urination. It is expected, from the presentation of this case, to motivate others to study and publish their findings on this condition in Cuba. It is the first time a patient asks for support for this cause to this author in his years of practice as a psychiatrist.

Elaboração de protocolo e cartilha sobre autocateterismo intermitente limpo em pacientes com bexiga neurogênica secundária a infecção por HTLV-1 / Preparation of protocol and primer on self-clean intermittent catheterization in patients with neurogenic bladder secondary to HTLV-1

Um elevado número de pacientes portadores de HTLV-1 com infecção urinária é internado anualmente no Instituto de Pesquisa Clínica Evandro Chagas (IPEC/FIOCRUZ). O cateterismo intermitente limpo é uma técnica eficaz para o esvaziamento vesical diminuindo o resíduo pós-miccional em indivíduos com bexiga neurogênica. Este estudo trata-se do desenvolvimento de um Protocolo Operacional Padrão (POP) para o treinamento do autocateterismo intermitente limpo nos pacientes com bexiga neurogênica secundária à infecção pelo HTLV-1 e de uma cartilha de aprendizagem do auto-cateterismo intermitente limpo a ser utilizado por esses pacientes. O estudo foi desenvolvido em duas etapas: Etapa-1, revisão de literatura nas bases de dados virtuais e construção do POP de acordo com as normas de qualidade do IPEC; Etapa-2, com base no POP construção da cartilha de auto-cateterismo com ilustrações e instruções do procedimento. A elaboração desses dois instrumentos visa uniformizar os cuidados com os portadores de bexiga neurogênica, promover maior participação e independência dos pacientes em seu tratamento, reduzindo os episódios de infecção urinária e as internações hospitalares por este motivo...

A high number of patients with HTLV-1 with urinary infection is hospitalized annually in theClinical Research Institute Evandro Chagas (IPEC/Fiocruz). The clean intermittentcatheterization is an effective technique for bladder emptying decreasing post-voiding residuein individuals with neurogenic bladder. This study deals with the development of a StandardOperating Protocol (SOP) for the training of the self-clean intermittent catheterization inpatients with neurogenic bladder secondary to HTLV-1 and a primer for learning the selfcleanintermittent catheterization to be used by these patients. The study was conducted in twostages: Stage-1, literature review on virtual databases and building SOPs in accordance withthe quality standards of the IPEC, Step-2, based on the SOP construction of primer selfcatheterizationwith illustrations and procedure instructions. The preparation of these twoinstruments aims to standardize the care of patients with neurogenic bladder, promote greaterparticipation and independence of patients in treatment, reducing episodes of urinary tractinfection and hospitalizations for this reason...

Manejo conservador de la bacteriuria asintomática en pacientes con lesión medular y vejiga neurogénica ingresados en el de rehabilitación Aldo Chavarría en el período comprendido del mes de agosto de 2008 a diciembre de 2009 / Conservative management of asymptomatic bacteriuria in patients with spinal cord injury and neurogenic bladder admitted to the rehabilitation Aldo Chavarria in the period from August 2008 to December 2009

Se realizó un estudio descriptivo, prospectivo de corte transversal; en los pacientes con diagnóstico de lesión medular y vejiga neurogénica que presentaron bacteriuria asintomática durante su ingreso en el Hospital Aldo Chavarría, en el período comprendido del mes de agosto de 2008 al mes de diciembre de 2009, con el objetivo de describir los aspectos relacionados a su manejo conservador. El universo fue de 85 pacientes y la muestra estuvo conformada por 38, su selección fue de tipo no probabilístico por conveniencia.Entre los resultados más importantes se puede destacar: El mayor número de casos fue en el grupo de edad de 25-34 años con 31.6%, con predominio del sexo masculino con un 89.5% de pacientes. El 57.9% de pacientes se trataba de Lesión Medular ASIA A.El 68.4% de las personas estudiadas tuvo sondaje con duración mayor de 30 días antes de iniciar el cateterismo.El 100% de pacientes no presentó sintomatología clínica sugestiva de infección urinaria. Al 57.9% de los pacientes en estudio se le realizó Examen General de Orina (EGO) y Urocultivo. La bacteria Klebsiella pneumoniae se aisló en 36.4% de casos y en igual proporción, el antibiograma mostró sensibilidad a Cefalosporinas y Aminoglucósidos. En el 100% de los casos estudiados, el antibiograma reveló resistencia a las Quinolonas...

Hinman syndrome; non-neurogenic neurogenic bladder

Inadequate bladder emptying is a common urinary dysfunction in children. Proper evaluation of the child to rule out neurogenic cause is highly desirable before labeling him/her a non-neurogenic neurogenic bladder. This case report describes a male child of 3 years age who presented with clinical features of neurogenic bladder but found to have no neurogenic cause hence diagnosed as Hinman syndrome. After diagnosis he was placed on alpha-adrenergic blocker. along with psychological support and showed satisfactory response

Usefulness of radiology and MRI in caudal regression syndrome

We report three patients with sacral and coccygeal agenesis based on observations of painful haematuria, urinary tract infection, and urine incontinence. All patients were examined by conventional radiology [urography and micturating urethrography] and imaging such as ultrasound and MRI. Neuropathic urinary bladder and pronounced reflux to the kidneys were observed. MRI of spine revealed conus medullaris located high [Th 11 and Th 12] and different from the expectations with respect to the patients' age. Neither tether cord nor intrathecal tumours were observed in our patients. In one patient, deformed and bulky cauda equina was described and in another the cauda equina was small and atrophic. In all patients, absence of a part of sacrum and coccyx and nerve roots innervating urinary bladder and sphincters were observed. MRI revealed good anatomical and pathological check up of kidneys and urinary tracts in the children suffering from chronic urosepsis

Validade dos sintomas urinários para o diagnóstico da instabilidade em mulheres incontinentes / Validity of the patient's symptoms in detecting instability in female urinary incontinence

Objetivo: Estudar a validade de cada pergunta do questionário de Hodgkinson modificado por Conceiçäo para o diagnóstico da instabilidade vesical. Pacientes e Métodos: Foi realizado um estudo retrospectivo dos dados de questionário e cistometrias de 473 mulheres encaminhadas para avaliaçäo urodinâmica. Os sintomas urinários obtidos através do questionário foram comparados com o resultado das cistometrias. A associaçäo foi pesquisada através do teste do X2, considerando-se significativo o valor de p<0,05. Foram também calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para as perguntas estatisticamente significativas. Resultados: Nossas análises revelaram que os sintomas de freqüência, urgência, incontinência por urgência, nictúria e enurese, a necessidade de acordar para urinar, a incapacidade de interromper o jato urinário, a ausência de sensaçäo de enchimento vesical e o grande volume de urina perdido associaram-se significativamente com a instabilidade do destrusor ("p"<0,05). Nenhum dos sintomas mostrou valores preditivos significativos. Os sintomas de urgência, incontinência por urgência, e a necessidade de acordar para urinar mostraram sensibilidade > 90 por cento, e a ausência de sensaçäo de enchimento vesical mostrou especificidade de 98 por cento. Conclusäo: Os sintomas pesquisados pelo questionário de Hodgkinson modificado por Conceiçäo näo säo um instrumento acurado para o diagnóstico da instabilidade vesical em mulheres com sintomas mistos

Validade dos sintomas urinários para o diagnóstico da incontinência de esforço genuína em mulheres com queixas mistas / Validity of the patient's symptoms in detecting genuine stress urinary incontinence in women with mixed symptoms

Objetivo: Estudar a validade das perguntas do questionário de Hodgkinson modificado por Conceiçäo para o diagnóstico da incontinência urinária de esforço. Método: foi realizado um estudo retrospctivo dos dados de questionários, cistometrias e teste de esforço de 473 mulheres encaminhadas para avaliaçäo urodinâmica. Os sintomas urinários obtidos através do questionário foram comparados com o resultado das cistometrias e testes de esforço. A associaçäo foi pesquisada através do teste do X2, considerando-se significativo o valor de p<0,05. Foram também calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para as perguntas estatitsticamente significativas. Resultados: Os sintomas de perda urinária aos esforços, freqüência da perda aos esforços, o uso de benzodiazepínicos e a percepçäo do enchimento visical associaram-se significativamente com a incontinência urinária de esforço genuína (p<0,05). Nenhum dos sintoma mostrou vslor preditivo positivo significativo; a resposta à pergunta FA 1 tem valor preditivo negativo de 88 por cento. O sintoma de incontinência urinária aos esforços e a percepçäo do enchimento vesical têm alta sensibilidade (>95 por cento), e o uso de benzodiazepínicos mostrou especificidade de 93 por cento. Conclusäo: Os sintomas pesquisados pelo questionário de Hodgkinson modificado por Conceiçäo näo devem ser o único instrumento para o diagnóstico da incontinência urinária de esforço em mulheres com queixas mistas

Neurogenic bladder: urodynamic and surgical aspects.

Children with spina bifida often have vesico-urethral dysfunction manifesting either as upper urinary tract deterioration or voiding dysfunction, chiefly incontinence. Surgery of the back and presence of or increase in hydrocephalus may contribute to neuro-urologic worsening; secondary cord tethering and syrinx or hydromyelia may be additional factors coming into play later in life. Urodynamic assessment using simple modalities like uroflowmetry, external sphincter EMG, residual urine volume and cystometry provide data useful to classify patients according to detrusor and sphincter activity. Besides diagnosis, urodynamic studies are useful in guiding therapy of children with vesico-urethral dysfunction, and for their follow-up to detect sub-clinical deterioration. They also help to prognosticate risk of upper tract deterioration and the possible success of measures to contain incontinence. Urodynamic data in thirty one patients with spinal dysraphism who presented to us with urologic symptoms were analysed. Twenty-three children had hyper-reflexic bladders while in the other 8 the bladder was areflexic. 13 children showed upper tract dilatation. The leak point volume was significantly lower in this group of patients compared to those who did not show upper tract dilatation. Our results are comparable to earlier similar studies.

Neurogenic bladder.

Management of neurogenic bladder in children is challenging for the practising clinician. This involves consideration of multiple and diverse factors which must be balanced in an ever changing environment. Also the dynamics of a child's growth must always be considered because it contributes to the ongoing instability of the neurologic lesion. Prevention and proactive approaches have become the mainstay of the therapy. It is not appropriate to wait for problems to occur before treating these children, because changes that take place may not be reversible, even if they are detected early. The clinician should be aware of the various clinical presentations of neurogenic bladder dysfunction in children and familiarize themselves with the modes of treatment available. Long term follow-up is mandatory. Finally, the value of streamlining these children into society at an early age must always be considered.

Inestabilidad vesical, tratamiento con cloruro de oxibutinina / Instability of the urinary bladder: treatment with oxibutinine chloride

Se trató con cloruro de oxibutinina, una muestra 40 pacientes con inestabilidad vesical, diagnosticada desde los puntos de vista clínico y urodinámico. A todos se les administró de 10-15 mgs./día de cloruro de oxibutinina, por una media de 12 meses (8-18 meses). El tratamiento y seguimiento, fue valorado tras un período de 6-38 meses (media de 20 meses). Desde el punto de vista clínico se obtuvo mejoría total en un plazo de tratamiento de 3 meses, en 20 pacientes (50/100) mejoría relativa con desaparición de algunos de los síntomas o disminución de intensidad de los previos en 18(45/100). No se obtuvo mejoría en 2 pacientes (5/100) Obtuvimos una mejoría global y relativa del 95/100. Desde el punto de vista urodinámico, desaparecieron los signos de inestabilidad de forma total en los 5 pacientes en que se efectuó control urodinámico. Entre los efectos secundarios encontrados, 38 pacientes manifestaron sequedad de boca, 5 pacientes náusea y vómitos, en 10 casos fue necesario reducir la dosis diaria de 15 a 10 mg.

Enterocistoplastia para el tratamiento y la reconstrucción vesical en el niño con vejiga neurogénica / Enterocystoplasty for the treatment and the bladder reconstruction in the child with neurogenic bladder

Se revisaron 20 pacientes con vejiga neurogénica de alto riesgo sometidos a enterocistoplastia. En 16 pacientes (80 por ciento) se realizó aumento vesical con colon sigmoideo, en tres (15 por ciento) con íleo y en uno (5 por ciento) con uréter. Todos experimentaban deterioro preoperatorio de las vías urinarias superiores, que en siete (35 por ciento) mejoró y en 13 (65 por ciento) se estabilizó, y en ninguno progresó. Tenían reflujo 16 pacientes (80 por ciento), que pudo curarse en 15 (94 por ciento). Otros 15 pacientes (80 por ciento) tenían incontinencia urinaria, y actualmente se conservan secos durante periodos de 31/2 a 4 horas. Los estudios cistométricos indicaron mejoría de 300 por ciento en la capacidad vesical, y disminución de 50 por ciento de la presión vesical. La función renal se estabilizó o mejoró en todos los pacientes. Se presentaron complicaciones sólo en cinco casos (20 por ciento), en dos por suboclusión intestinal, en otros dos por infección de vías urinarias sintomática y en uno por litiasis vesical. Estos resultados corroboran que la enterocistoplastia es la mejor opción de tratamiento en vejigas de alto riesgo y deterioro de vías urinarias superiores

Recomendaciones para pacientes con vejiga neurógena / Recomentations for patients with neurogenic bladder

La difusión de medidas que permitan prevenir mayores complicaciones cuando ya está presente una patología, y la necesidad de facilitar una vida más adecuada a aquellos individuos afectados por una enfermedad, como es la vejiga neurogéna, es el objetivo que persigue este artículo dirigido a médicos y enfermeras, al entregar algunas indicaciones prácticas para que sean dadas a conocer al paciente y a sus familiares

Urodinamia inferior en niños / Urodynamic of the lower urinary tract in children

Se presenta el análisis de 108 pacientes con edades entre 2 y 19 años estudiados en la consulta de Urodinamia del Hospital San Juan de Dios de Caracas. Distinguimos dos grupos en base a que el niño tuviese historia de mielomaningocele (44 casos) o no (64 casos). en 21. existía alguna uropatía conocida y 9 de ellos habían sido operados previamente. En el grupo con mielomeningocele el síntoma predominante fue la incontinencia y en el otro la infeccion. Los procedimientos utilizados fueron la cistometría, flujometría, perfil uretral y E.M.G. En todos los 108 casos se realizó al menos un procedimiento; en 19 se repitió una vez y en 5 dos veces. El más utilizado fue la cistometría y el menos usado el E.M.G. la evaluación urodinámica fue base para la indicación farmacológica en 68,18% de los niños con mielomeningocele, obteniendo buenos resultados sólo en 16,66%. En el otro grupo encontramos fundamentos para la farmacología en 48,43%, con buenos resultados en 38,70%