Estudo e prevalência de bexiga neurogênica em pessoas com lesão medular traumática e não traumática no Brasil / Study and prevalence of neurogenic bladder in users with traumatic and non-traumatic spinal cord injury in Brazil

A bexiga neurogênica, frequentemente associada à lesão medular de causa traumática e não traumática, é uma disfunção vesical decorrente de alterações no sistema nervoso. Este estudo investigou e analisou a bexiga neurogênica, sua prevalência e manejo em pessoas com diagnóstico de lesão medular traumática (LMT) e não traumática (LMNT) em uma rede de hospitais de reabilitação. Tratou-se de um estudo quantitativo, transversal, exploratório, descritivo e analítico. Para responder à questão central do estudo, foi selecionada uma amostra com 954 participantes, probabilística, aleatória estratificada, das seis unidades da rede participantes do estudo, com dados coletados diretamente dos prontuários eletrônicos. A prevalência de bexiga neurogênica foi de 94,65% (n=903), 67% tinham diagnóstico de lesão medular traumática e 33% de lesão medular não traumática, 69,32% eram homens e 30,68%, mulheres, com média de idade de 46,12 anos (DP=13,26). O cateterismo vesical intermitente foi a principal forma de esvaziamento (66,11%), e a maioria realizava o autocateterismo intermitente (74,04%). A micção voluntária foi associada ao tipo de lesão, sendo mais prevalente entre os participantes com LMNT (p≤0,001, Teste Qui-quadrado). Para investigação urológica, 93,36% realizaram exames de ultrassonografia renal e vias urinárias e 87,82%, estudo urodinâmico. A irregularidade da parede vesical (p≤0,029, teste Qui-quadrado de Pearson), o espessamento vesical (p ≤ 0,001, teste Qui-quadrado de Pearson) e a hiperatividade detrusora (p≤0,009, teste Qui-quadrado de Pearson) também apresentaram diferença estatística de acordo com o tipo de lesão, mais prevalentes nos participantes com LMT. Assim como a dilatação pielocalicinal, mais prevalente nos participantes com LMNT (p≤0,025, teste Qui-quadrado de Pearson). Os participantes com LMT apresentaram maior pressão detrusora média, 38,73cmH2O vs. 30,17cmH2O do que os com LMNT (p ≤ 0,001, teste de Mann- Whitney). Sabe-se que a bexiga neurogênica de pessoas com lesão medular traumática tende a apresentar maior número de complicações e maior risco para o trato urinário superior, principalmente quando há relação com a presença de pressão elevada, baixa complacência e capacidade vesical reduzida. Este estudo evidenciou diferenças importantes entre o perfil de pessoas com lesão medular traumática e não traumática, mostrando a necessidade do manejo personalizado de acordo com a causa da lesão medular.

Neurogenic bladder is a dysfunction that results from changes in the nervous system, and is frequently associated with traumatic and non-traumatic spinal cord injuries. This study investigated and analyzed the neurogenic bladder, its prevalence and management in people diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) in a network of rehabilitation hospitals. This is a quantitative, transversal, exploratory, descriptive and analytical study. A probabilistic, stratified random sample, composed of 954 participants, was used to answer the research question. Participants were selected from six of the hospital-network units and data were directly retrieved from electronic medical records. The prevalence of neurogenic bladder was 94.65% (n = 903), where 67% had a diagnosis of traumatic spinal cord injury and 33% non-traumatic spinal cord injury, 69.32% were male and 30.68% female, with a mean age of 46.12 years (SD = 13.26). The main draining method was intermittent bladder catheterization (66.11%), in most cases performed as intermittent self-catheterization (74.04%). Voluntary urination was associated with the type of injury, being more prevalent among participants with non-traumatic spinal cord injury (NTSCI) (p≤0.001, Chi- Square Test). For urological investigation, 93.36% of the participants were submitted to a renal and urinary-tract ultrasound scan and 87.82% to urodynamics. Bladder wall irregularity (p≤0.029, Pearson's chi-square test) and thickening (p ≤ 0.001, Pearson's chi-square test), and detrusor hyperactivity (p≤0.009, Pearson's chi-square test) also presented a statistical difference according to the type of injury, with a higher prevalence in participants with traumatic spinal cord injury (TSCI). That was also the case of pyelocaliceal dilation, which was more prevalent in participants with NTSCI (p≤0.025, Pearson's Chi-square test). Participants with TSCI showed a mean detrusor pressure of 38.73 cmH2O, higher than the value of 30.17 cmH2O recorded for those with NTSCI (p ≤ 0.001, Mann-Whitney test). It is known that a neurogenic bladder in people with traumatic spinal cord injury tends to have a greater number of complications and greater risk for the upper urinary tract, especially when there is a relationship with the presence of high pressure, low compliance and reduced bladder capacity. This study unveiled important differences in the profiles of people with traumatic and non-traumatic spinal cord injury, highlighting the need for treatment to be tailored according to the cause of the spinal cord injury.

[Urinary tract Complications in 94 Patients with spinal dysraphisms]

Congenital neurospinal dysraphism is the most common cause of neurogenic bladder among children. Myelomeningocele, which is the most common type of these lesions, is associated with neurogenic bladder in more than 90 percent of cases. Due to critical consequences of this disorder and high worldwide prevalence of urinary complications in these patients and because of no previous studies in our country, we evaluated patients with various types of spinal dysraphism refered to Labbafinejad and Mofid hospital between 1999 and 2005. In this study which was carried out on existing data, we evaluated 94 patients with various types of spinal dysraphisms. Type of spinal dysraphism, history of pyelonephritis, vesicoureteral reflux, renal damage, urinary incontinence, paraclinic findings, type of treatment and outcome of disease were reviewed in the patients records and these data were entered into a data sheet and reported by descriptive-analytic statistics. Sixty eight patients [72.3%] had at least one episode of pyelonephritis. Hydronephrosis was reported in 34.1% of patients as well as vesicoureteral reflux in 35.1%, renal atrophy in 13.9% and end stage renal failure in 3.2% of them. Among 61 patients aged 4 years or older, 47 [77%] had urinary incontinence. Urodynamic studies were performed in 17% of patients to evaluate lower urinary tract function. Seventy six cases [80.9%] had paraclinic findings in favour of neurogenic bladder, from whom 59.2% had recieved medical treatments [CIC, anticholinergic agents, or both] to improve complications of this disorder; the mean age of these patients was 4.8 +/- 4.4 years at the onset of medical treatments. Cystoplasty was performed in 35.1% of cases. Antireflux surgery was also performed in 9 patients [9.6%]. 7 cases out of them underwent surgery without having any treatment for the underlying cause of reflux; in later follow-up, vesicoureteral reflux had relapsed in 6 cases of these latter group. It seems that urodynamic studies are the most accurate means in evaluation of lower urinary tract function and performing these studies in patients with spinal dysraphisms [in newborn period or early infancy] is necessary for diagnosis of urinary tract dysfunction and planning up the most appropriate management for these patients. Failure to treat the underlying cause of secondary vesicoureteral reflux would significantly jeopardize the success rate of any surgery that might inadvertently be done in an attempt to correct the problem

Etiology of chronic renal failure in children; experience at king Hussein medical center

To determine the spectrum and etiology of chronic renal failure, for patients followed up in the pediatric nephrology clinic at King Hussein Medical Center, as well as to determine the prevalence and other demographic features for patients with chronic renal failure in Jordan. A registry analysis of all children with chronic renal failure followed in the pediatric nephrology clinic at King Hussein Medical Center during the year 2004 was conducted. Chronic renal failure was defined as having glomerular filtration rate <80 ml/ min / 1.73m[2]. Demographic data such as sex, height, and date of birth, as well as the serum BUN, creatinine, diagnosis and the duration of chronic renal failure at the time of follow up were all recorded. Chronic renal failure was calculated from serum creatinine based on Schwartz formula. CRF was divided to 4 stages according to the Kidney Disease Outcomes Quality Initiatives guidelines, for stratification of chronic kidney disease. A total number of 117 patients, 64 [54.7%] males, and 53 [45.3%] females were included in the study. Statistical Package for Social Studies version 10 was used to analyze the data. Values are given in means +/- standard deviation unless otherwise stated. The mean age was 8.6 +/- 4.7 years, and the mean duration of follow up was 6.7 +/- 2.3 years. The mean glomerular filtration rate for the whole study population at the time of recording was 28.6 +/- 19.58 ml/min/ 1.73m[2]. It was shown that the prevalence of chronic renal failure among Jordanian children in the year 2004 to be 75 patients per million-child population. The most common cause of chronic renal failure was Reflux Nephropathy [30.8%] of total, followed by Neurogenic Bladder [17.9%]. Reflux Nephropathy, and Obstructive Uropathy were more common in males when compared to females; where as Neurogenic Bladder and Hemolytic Uremic Syndrome were more common in females. The most common cause of chronic renal failure in patients with end stage renal disease at King Hussein Medical Center was glomerulonephritis [19.4%], followed by oxalosis [16.1%].The etiology of chronic renal failure in Jordan is similar to other places with some peculiar features that need further study including the high prevalence of neurogenic bladder, and oxalosis. The importance of establishing a national and possibly regional registry system for pediatric chronic renal failure is well illustrated by this study

Complicaciones urológicas de los pacientes portadores de mielodisplasia / Complications in patients of myelodysplasic carrier state

Creemos que los pacientes con mielodisplasia (mds) y sus complicaciones, deben ser atendidos en forma multidisciplinaria; para lo cual, en el Servicio de Cirugía Pediátrica del Hospital Ramón Madariaga, desde agosto de 1987, intentamos definir situaciones y normas de trabajo aplicables en forma efectiva en nuestra población. Se destacan los objetivos máximos buscados para estos pacientes. Desarrollamos el protocolo inicial o investigación primaria. Proponemos una clasificación de Vejiga Neurogénica-clínica-radiológica e infecciosa, utilizando a esta para tabular las normas de seguimiento y tratamiento urológico en estos pacientes. Este trabajo presenta los primeros 30 pacientes seguidos y tratados bajo estas normas