ABSTRACT
A retrospective co-operative study was conducted among 6 Italian paediatric surgical departments to assess the results of different forms of treatment of vesicoureteric reflux in patients with neurogenic bladder. Between January 1980 and December 1989 we studied 641 neurogenic bladders in children, mainly due to spina bifida; reflux was detected in 199 patients with 263 refluxing ureters. Details of treatment were available for only 170 patients and they were divided into 2 main groups: conservative medical treatment (n = 127) and primary surgical treatment (n = 43). Medical treatment consisted mainly of clean intermittent catheterisation and the administration of appropriate drugs. In the surgical group 36 reimplantations, 6 cystostomies and 1 STING were performed. Fifteen patients underwent surgery as a secondary procedure. The results showed that approximately 50% of patients with reflux were cured by clean intermittent catheterisation and drug therapy. Ureteric reimplantation can be safely performed in patients with neurogenic bladder provided that a normally compliant, non-hyper-reflexic bladder can be achieved by means of drugs or by bladder augmentation with bowel.
Subject(s)
Urinary Bladder, Neurogenic/complications , Vesico-Ureteral Reflux/therapy , Child , Cystostomy , Humans , Replantation , Retrospective Studies , Spinal Dysraphism/complications , Ureter/surgery , Urinary Bladder, Neurogenic/etiology , Urinary Catheterization , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/surgeryABSTRACT
The aim of the study is to define the role of associated malformations in the clinical evolution of children affected by myelomeningocele. MRI investigation of the spinal cord was carried out on 25 patients between the age of 7.3 and 18.10 with MMC repaired and followed up for at least 7 years. The relation between associated malformations demonstrated by MRI and clinical trend was analysed. The results are the following: 1) presence of asymptomatic tethered cord in all cases; 2) high frequency (92%) of Chiari malformation; 3) presence of syringomyelia in 20% of patients, symptomatic in 1; 4) presence of ventricular enlargement in 72% of cases without increased intracranial pressure syndrome. For a better therapeutic approach prospective MRI studies are needed in order to follow up associated malformations.
Subject(s)
Magnetic Resonance Imaging , Meningomyelocele/diagnosis , Meningomyelocele/surgery , Adolescent , Cerebral Ventricles/pathology , Child , Female , Follow-Up Studies , Humans , Hydrocephalus/complications , Hydrocephalus/diagnosis , Hydrocephalus/surgery , Male , Meningomyelocele/physiopathology , Postoperative Period , Spinal Cord/abnormalities , Spinal Cord/pathology , Spinal Cord/physiopathologyABSTRACT
Retrocaval ureter is a rare anomaly, often misdiagnosed for years, presenting with sign of urinary infections and obstruction. Recognition of this anomaly is rare in childhood. We report a case of a 9 years old boy, who was successfully treated by ureteral section, excision of the retrocaval segment and uretero-ureteral anastomosis. Current diagnostic procedures and different methods of treatment are reviewed.
