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Evaluation of clinico-urodynamic outcome of bladder dysfunction after surgery in children with spinal dysraphism - a
1Department of Neurosurgery, Sanjay Gandhi Institute of Postgraduate Medical Sciences, Lucknow, India. rajkumar@sgpgi.ac.in
Insights
Children with spinal dysraphism often experience bladder dysfunction. Pre-operative urodynamics help assess severity, with better surgical outcomes typically seen in closed spinal dysraphism cases.
Area of Science:
- Pediatric Urology
- Neuroscience
- Surgical Outcomes
Background:
- Spinal dysraphism presents complex challenges in pediatric care.
- Bladder dysfunction is a common complication requiring thorough assessment.
Purpose of the Study:
- To evaluate the clinical and urodynamic profiles of children with spinal dysraphism.
- To assess surgical outcomes for these patients.
Main Methods:
- Prospective study of 25 children (10 open, 15 closed spinal dysraphism) from 2005-2006.
- Pre-operative clinical assessment, urodynamic evaluation, and kidney ultrasound.
- Post-operative re-evaluation at 6-8 months.
Main Results:
- 14/25 children had pre-operative bladder involvement; 19/25 showed urodynamic dysfunction.
- Open spina bifida cases showed higher rates of clinical and urodynamic bladder dysfunction.
- Post-operative improvement was noted in 9/20 children, with better outcomes in closed dysraphism.
Conclusions:
- Open spinal dysraphism is associated with greater bladder dysfunction than closed forms.
- Pre-operative urodynamics are crucial for identifying bladder dysfunction severity.
- Surgical outcomes are generally better for closed dysraphism, though some patients may deteriorate.
Background:
The aim was to asses the clinical profile and urodynamic findings and the outcome of surgery in children with spinal dysraphism.
Method:
Twenty five children with spinal dysraphism who were treated at our institute between January 2005 and June 2006 were studied prospectively. There were 10 with an open spina bifida and 15 closed. The clinical profile of bladder dysfunction was assessed and urodynamic evaluation done pre-operatively in each child. An ultrasound study of the kidneys was also done to assess for hydro-uretero-nephrois. All underwent surgery for their primary and associated malformations. Post-operatively, re-evaluation of bladder dysfunction and urodynamic parameters was performed at 6-8 months.
Results:
Before operation there was a history indicating that the bladder was involved in 14 of the 25 children. Six of the 10 cases with an open spina bifida showed clinical involvement of the bladder as compared to 8 of 15 with a closed pattern. Urodynamic studies showed evidence of bladder dysfunction in 19 children. Of 10 with a meningomyelocele, there were abnormal urodynamics in 9 as compared to 10 of 15 with closed dysraphism. Follow up urodynamic studies showed improvement in 9 of 20 children 3 of 7 with a meningomyelocele and 6 of 13 with closed dysraphism.
Conclusion:
Children with open spina bifida, as compared to closed dysraphism, tend to have more bladder dysfunction as exemplified on clinical history and urodynamic assessment. A pre-operative urodynamic study helps to identify severity of bladder dysfunction which is clinically overt cases and also identifies subtle bladder dysfunction in clinically silent cases. Evaluation after operation tends to shows better outcome in children with closed dysraphism. The study also identifies deterioration in some patients with seemingly clinical improvement.
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