Pediatric Neurogenic Bladder Dysfunction

This book provides a leading international reference on the diagnostic and therapeutic approach to the pediatric patient with urinary problems due to spinal cord pathologies.

Pediatric Neurogenic Bladder Dysfunction

Pediatric Neurogenic Bladder Dysfunction

This book provides a leading international reference on the diagnostic and therapeutic approach to the pediatric patient with urinary problems due to spinal cord pathologies. It represents a unique guide for specialists involved in the management of this pathology. The text is well illustrated with figures.

Neurogenic bladder and bowel dysfunction

Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family.

Neurogenic bladder and bowel dysfunction

Neurogenic bladder and bowel dysfunction

Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder and bowel dysfunction—with the risk of urinary tract infections, renal deterioration, urinary and fecal incontinence—that affects social participation and quality of life negatively. In newborns with SD, early detection of neurogenic bladder dysfunction and determination of post-void residual urine are required to determine the need of clean intermittent catheterization (CIC) and follow-up. The non-invasive method of four-hour voiding observation with provocation test (VOP) was used to evaluate bladder function in 50 newborn children with SD. Voiding patterns for the children were described and compared with those of 50 healthy newborns evaluated with VOP in an earlier study. Comparison revealed significant differences among several variables. In particular, leakage at provocation test and not voiding with a stream were common in newborns with SD but did not occur in healthy newborns. VOP is a non-invasive standardized method to determine residual urine in newborns with SD. It also adds information on voiding pattern, frequency, voiding with a stream and leakage at provocation. Findings in neonatal VOP of the same cohort of newborns with SD were then related to radiology, presence of urinary tract infections during the first year, and urodynamic findings and use of CIC at the age of one year. It was found that, in children with SD, not voiding with a stream may have a predictive value for the need of CIC at the age of one year, followed probably by lifelong CIC. Despite this, the presence of an open SD per se has stronger predictive value, and each child needs to be evaluated individually while considering a number of factors. The main value of VOP may be as a structured non-invasive screening method to uncover neurogenic bladder-sphincter dysfunction in the newborn. Studies with a larger number of subjects than the present are needed to evaluate the potential of VOP in newborns with closed spinal dysraphism in whom the neurological consequences vary. A retrospective analysis detected renal damage on DMSA scintigraphy in 5 of 41 children with SD who were followed according to a proactive national program with minimal use of surgery. Median follow-up time was 10 years. High baseline pressure was confirmed as a risk factor for renal damage. Compliance with treatment and follow-up is likely to be an important factor for renal health. Therefore, efforts to support children and their families are crucial. A questionnaire-based study of 107 children with SD (age 6–16y) in Sweden and Norway examined aspects of treatment for neurogenic bowel dysfunction focusing on incontinence, independence, general satisfaction and quality of life. It was found that transanal irrigation (TAI) and antegrade colonic enemas (ACE) are effective treatments, but are time-consuming and difficult to perform independently. The majority of children using TAI (72%) and ACE (63%) never went to the toilet alone to empty their bowels. As children achieving independence on the toilet reported higher quality of life, efforts to support independence are beneficial. Continent, self-managing children with healthy kidneys enjoy high quality of life and contribute more fully to society. Therefore, further research is required to investigate and develop existing and new technologies and methods that mitigate the problems related to SD, and to make them accessible to all children with spinal dysraphism. Under de senaste 50 åren har det skett en enastående utveckling av möjligheterna för barn som föds med ryggmärgsbråck. Tidigare har majoriteten av barn med ryggmärgsbråck avlidit redan som spädbarn men idag överlever de flesta till vuxen ålder. Utan aktiva insatser och uppföljning är dock risken för medicinska problem och allvarlig påverkan på livet mycket stor. Nu när nästan alla barn överlever ligger fokus på att också nå okad livskvalitet och självständighet för personer med ryggmärgsbråck. Nästan alla med ryggmärgsbråck måste hantera en allvarlig påverkan på blåsan och tarmen med risk för njurskador, inkontinens och förstoppning. I avhandlingens två första studier värderade vi en metod att, med minimalt obehag för barnet, bedöma blåsfunktionen. Detta för att kunna skilja ut de barn som behöver genomgå mer avancerade undersökningar och få hjälp med blåstömningen genom täta tappningar med kateter, sa kallad ren intermittent kateterisering, RIK. När vi jämförde resultatet av testet för 50 nyfödda med ryggmärgsbråck med samma undersökning av 50 friska nyfödda fann vi stora skillnader. Mest tydligt var att de flesta nyfödda med ryggmärgsbråck (69%) men inga friska nyfödda läckte urin när man tryckte över blåsan. Av nyfödda med ryggmärgsbråck kissade de flesta (74%) inte med stråle vilket alla friska nyfödda gjorde. Att inte kissa med stråle talade också starkt för att barnet skulle komma att behöva hjälp med RIK för att tomma blåsan vid ett ars ålder, och då sannolikt livet ut. Sammantaget visade avhandlingens två första arbeten att den metod för bedömning av blåsfunktion vi undersökt kan användas för att styra uppföljning och behandling av nyfödda med ryggmärgsbråck. Avhandlingens tredje studie visade att aktiv uppföljning av barnen enligt ett nationellt vårdprogram lyckades förhindra njurskador hos de flesta, men att höga tryck i urinblåsan och återkommande urinvägsinfektioner ökade risken för skador. Även familjernas förmåga att i en pressad vardag klara av att genomföra de ofta krävande behandlingar och undersökningar som rekommenderas verkade vara viktig för att förhindra njurskador. Stöttning av familjerna är därför viktig. Avhandlingens fjärde arbete berörde tarmen som nästan alltid är påverkad vid ryggmärgsbråck, med risk för svår förstoppning och avföringsläckage. Detta har påtaglig påverkan på barnen och deras familjer. En tredjedel av de 107 familjerna i vår enkätundersökning i Sverige och Norge (barn 6-16 år) beskrev att man fått avstå från aktiviteter såsom resor på grund av barnets tarmproblem och de barn som hade avföringsläckage rapporterade tydligt lägre livskvalitet än andra. Trots denna allvarliga påverkan finns det hittills inga studier som jämför de olika behandlingar som barnet kan använda. I vår enkät kartlade vi därför vilka metoder som användes och hur bra de fungerade. Vi ställde frågor till både barn och föräldrar, särskilt om avföringsläckage, hur nöjd man var med metoden, barnens livskvalitet och självständighet på toaletten. Det var utifrån svaren tydligt att båda de vanligaste typerna av tarmsköljning var effektiva men tidskrävande och svara för barn och ungdomar att klara att utföra på egen hand. Ingen metod visade sig överlägsen den andra men de barn som klarade att skota tarmtomningen själva skattade sin livskvalitet klart högre än övriga. Vi drar därför slutsatsen att det är viktigt att vårdpersonal diskuterar de olika behandlingsalternativen med barn och föräldrar, och tillsammans med dem väljer den metod som passar det enskilda barnet bäst. Då skapas bästa förutsättningar för att gemensamt arbeta vidare för att uppnå största möjliga självständighet. Självständiga individer, med friska njurar och utan urin- och avföringsinkontinens upplever högre livskvalitet och behöver mindre sjukvård och andra samhällsinsatser. Det behövs mer forskning för att utveckla existerande och nya metoder att hantera de allvarliga komplikationer som riskerar att drabba barn och vuxna med ryggmärgsbråck.

Pediatric Incontinence

Perfect to refer to prior to seeing patients on the wards and in the clinics, this is the ideal guide to the topic and an essential purchase for all urologists, pediatric urologists, pediatric nephrologist, pediatricians, psychiatrists, ...

Pediatric Incontinence

Pediatric Incontinence

Pediatric incontinence: evaluation and clinical management offers urologists practical, 'how-to' clinical guidance to what is a very common problem affecting up to 15% of children aged 6 years old. Introductory chapters cover the neurophysiology, psychological and genetic aspects, as well as the urodynamics of incontinence, before it moves on to its core focus, namely the evaluation and management of the problem. All types of management methods will be covered, including behavioural, psychological, medical and surgical, thus providing the reader with a solution to every patient's specific problem. The outstanding editor team led by Professor Israel Franco, one of the world’s leading gurus of pediatric urology, have recruited a truly stellar team of contributors each of whom have provided first-rate, high-quality contributions on their specific areas of expertise. Clear management algorithms for each form of treatment support the text, topics of controversy are covered openly, and the latest guidelines from the ICCS, AUA and EAU are included throughout. Perfect to refer to prior to seeing patients on the wards and in the clinics, this is the ideal guide to the topic and an essential purchase for all urologists, pediatric urologists and paediatricians managing children suffering from incontinence.

Neuropathic Bladder in Childhood

This is the first book to cover comprehensively all aspects of the management of the neuropathic bladder in the pediatric age group. The most recent advances in the assessment and management of these children are fully discussed.

Neuropathic Bladder in Childhood

Neuropathic Bladder in Childhood

This is the first book to cover comprehensively all aspects of the management of the neuropathic bladder in the pediatric age group. The most recent advances in the assessment and management of these children are fully discussed. The reader is taken logically through the neurology and diagnosis of neuropathic bladder, investigations, and indications for surgical and nonsurgical intervention. There are sections on the management of infection, renal problems, constipation, and sexual problems, and there is a review of the psychological problems encountered by these children and their families.

Clinical Urodynamics in Childhood and Adolescence

This book aims to impart all the practical knowledge required in order to evaluate and treat children with anatomical, neurological, and functional incontinence.

Clinical Urodynamics in Childhood and Adolescence

Clinical Urodynamics in Childhood and Adolescence

This book aims to impart all the practical knowledge required in order to evaluate and treat children with anatomical, neurological, and functional incontinence. It explains how appropriate choice of management in childhood depends first of all on a correct diagnosis, then on thorough urodynamic evaluation, and finally on sound assessment of the condition of the individual patient. The full range of relevant pathologies are considered and all of the treatment options are extensively discussed, including behavioral therapy, rehabilitation, physiotherapy, pharmacotherapy, neuromodulation, endoscopic procedures, and surgical reconstruction. Careful attention is paid to the impacts that treatments performed during childhood may have on later adult life, including on fertility and pregnancy, with a view to ensuring that the reader will be in a position to time treatments correctly, thereby avoiding adverse effects, and possess all the information needed to address the concerns of patients and their families. The book will be of value to pediatricians, urologists, nurses, physiotherapist, students, and all others with an interest in the field.

Urinary Tract Anomalies and Infections in Children ECAB

The book also contains a chapter on the management and long-term outcome of common kidney and urinary tract anomalies detected on antenatal screening such as unilateral or bilateral hydronephrosis, multicystic dysplastic kidneys, and ...

Urinary Tract Anomalies and Infections in Children   ECAB

Urinary Tract Anomalies and Infections in Children ECAB

Urinary tract disorders, be they anomalies or infections, are an important cause of acute and long-term morbidity in children. These conditions need prompt diagnosis and management, not only to relieve the acute morbidity, but also to prevent the long-term renal damage. This makes diagnostic and therapeutic issues concerning these conditions very important. The most common urinary problem encountered in children is urinary tract infection (UTI), which is usually bacterial in origin. Urinalysis and culture play an important role in the diagnosis of this condition. The treatment consists of prompt and specific antibiotic therapy followed by genitourinary imaging in high risk patients to detect underlying urinary tract anomalies. Vesicoureteric reflux (VUR) is characterized by retrograde flow of urine from the bladder to the kidneys, thereby predisposing it to UTI, and the two conditions together are believed to be associated with renal nephropathy. Patients with VUR have an increased risk of developing hypertension, toxemia of pregnancy, and significant renal damage, including end-stage renal disease subsequently in life. Based on the current literature, the author has enumerated various treatment options available for the different grades of VUR. The urinary bladder is meant to function as a storage organ for urine that empties completely in an appropriate time and place. Any disorder that results involuntary passage of urine or inability to void to completion constitutes bladder dysfunction. Bladder dysfunction is increasingly recognized as a risk factor for UTI and VUR, and a cause for enuresis with daytime symptoms. Its diagnosis requires detailed clinical history and examination, non-invasive urodynamic tests, frequency volume charts, and abdominal ultrasonography to predict the type of bladder dysfunction. The author has emphasized on the importance of multidisciplinary approach in its management, comprising of medications, treatment of any underlying cause, scheduled voiding regimen, clean intermittent catheterization, positive reinforcement and where necessary, biofeedback strategies. The book also contains a chapter on the management and long-term outcome of common kidney and urinary tract anomalies detected on antenatal screening such as unilateral or bilateral hydronephrosis, multicystic dysplastic kidneys, and posterior urethral valves.

Urology for the Pediatrician An Issue of Pediatric Clinics E Book

The articles in this issue update important topics in pediatric urology, but also address some of the more controversial clinical topics.

Urology for the Pediatrician  An Issue of Pediatric Clinics   E Book

Urology for the Pediatrician An Issue of Pediatric Clinics E Book

The articles in this issue update important topics in pediatric urology, but also address some of the more controversial clinical topics. Those topics included in this issue are Prenatal Ultrasound and Urological Anomalies, Spina Bifida and Neurogenic Bladder, Inguinal and Genital Anomalies, Voiding Dysfunction, Vesicoureteral Reflux, Hydronephrosis, Urolithiasis in Children, Urinary Tract Infection (UTI) work up, Advances in Surgical Pediatric Urological Armamentarium, Pediatric Urologic Oncology, Pediatric Urological Emergencies, and Circumcision Controversies.

Pediatric Uroradiology

Where appropriate, new contents have been included, e.g., on genetics, while other information that continues to be pertinent has been retained. This book describes in detail all aspects of pediatric uroradiology.

Pediatric Uroradiology

Pediatric Uroradiology

This fully updated and revised edition of a classic work takes full account of recent dramatic changes in the subject area. It describes in detail all aspects of pediatric uroradiology, embracing both recent developments and established concepts. New chapters have been added, for example on genetics in nephrourology and clinical management of important nephrourologic disorders. Short conclusions are included at the end of sections to provide the reader with key information.

Pediatric Urology An Issue of Urologic Clinics

In consultation with Consulting Editor, Samir Taneja, the Guest Editors have created an issue that provides a current look at urologic disease in the pediatric patient.

Pediatric Urology  An Issue of Urologic Clinics

Pediatric Urology An Issue of Urologic Clinics

In consultation with Consulting Editor, Samir Taneja, the Guest Editors have created an issue that provides a current look at urologic disease in the pediatric patient. Authors represent the top academic institutions and have contributed review articles on the following topics: Antibiotic Prophylaxis; Peritransplant Management by the Pediatric Urologist; Pediatric Stone Disease; Anesthesia in the Pediatric Patient; Neurogenic Bladder/Augmentation; Fertility Issues in Pediatric Urology; Transitional Urology; Minimally Invasive Surgery Update; Exstrophy Epispadias and Global Urology; Bladder/Bowel Dysfunction; Prenatal Hydronephrosis; and Overview of DSD/Genital Surgery in Children. Readers will come away with the clinical updates they need for proper diagnosis and treatment of the pediatric patient.

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