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[Treatment of infra-vesical obstructions in neurologic bladders. 27 cases]
Insights
This study investigated infra-vesical obstruction in 27 spina bifida cases, finding sphincter disorders in boys treated with sphincterotomy and uncertain causes in girls. Results on continence and upper tract effects are preliminary.
Area of Science:
- Urology
- Pediatric Surgery
- Developmental Biology
Context:
- Spina bifida is a complex congenital condition with significant urological implications.
- Infra-vesical obstruction is a recognized complication impacting bladder function and upper urinary tract health.
- Understanding the specific causes and effective treatments for infra-vesical obstruction in spina bifida patients is crucial for improving outcomes.
Purpose:
- To analyze the urological findings in a cohort of spina bifida patients with infra-vesical obstruction.
- To evaluate the efficacy of sphincterotomy in male patients with striated sphincter disorders.
- To explore the nature of infra-vesical obstruction in female patients and assess treatment outcomes.
Summary:
- The study reviewed 176 spina bifida cases, identifying infra-vesical obstruction in 27 patients based on dysuria, residue, and infection.
- Eleven boys with striated sphincter disorders underwent sphincterotomy, with outcomes assessed for continence and upper tract effects.
- Sixteen female patients presented with more uncertain infra-vesical obstruction, including one treated with Y-V plasty; results for residue, retention, dysuria, continence, and upper tract status were recorded.
Impact:
- This research highlights the varied presentation of infra-vesical obstruction in spina bifida, differentiating between male and female patients.
- The findings provide preliminary insights into the management of striated sphincter disorders via sphincterotomy in boys.
- Further long-term studies are needed to draw definitive conclusions on treatment efficacy and impact on urinary continence and upper tract preservation.
Abstract:
Of a total of 176 cases of spina bifida observed from a urological standpoint, we detected an infra-vesical obstruction in 27, the diagnosis being based upon urological findings alone: dysuria, residue and infection. The 11 boys had a disorder of the striated sphincter justifying sphincterotomy, the technique and results of which are discussed, in terms of symptoms and signs resulting from the obstruction, with respect to continence and the effects on the upper tract. 16 of our patients were female and the nature of the infra-vesical obstruction was far more uncertain. A disorder of the striated sphincter was present in the girl treated by a Y-V plasty of the anterior aspect of the bladder neck passing low down on the anterior aspect of the urethra. We also present results relating to residue, retention, dysuria, continence and the upper urinary tract. Overall, these results are too recent and difficult and no definite conclusions may be drawn.