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Pediatric spinal cord injury: approach for urological rehabilitation and treatment
M Silveri1, L Salsano, M M Pierro
1Department of Pediatric Surgery, Ospedale Pediatrico "Bambino Gesù"-Palidoro, Via Torre di Palidoro, 00050 Palidoro, Rome, Italy. maxsilveri@tin.it
Insights
Early urological management for pediatric spinal cord injuries (SCIs) is crucial. Prompt treatment improves bladder function and prevents upper urinary tract damage, leading to better continence outcomes.
Area of Science:
- Urology
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Spinal cord injuries (SCIs) in children can lead to significant bladder dysfunction.
- Delayed or inadequate management can result in upper urinary tract complications and renal failure.
- Early intervention is essential for optimal outcomes in pediatric SCI patients.
Purpose of the Study:
- To emphasize the mandatory nature of early urological rehabilitative management for pediatric SCIs.
- To prevent poorly compliant bladders, upper urinary tract complications, and secondary renal failure.
- To establish a rapid and appropriate treatment approach for children with traumatic SCIs.
Main Methods:
- A retrospective review of 17 pediatric SCI patients (mean age 9.6 years) over 5 years.
- Standardized diagnostic approach including video-urodynamic evaluation before and after treatment.
- Assessment of continence scores, bladder capacity, reflex volume, and end-filling pressure.
- Rehabilitation treatments included catheterization and medication, with follow-up ranging from 12 to 60 months.
Main Results:
- 16 out of 17 patients presented with neurogenic overactive bladder and detrusor sphincter dyssynergia.
- Mean bladder capacity was 287.7 ml, with mean reflex volume of 119.7 ml and end-filling pressure of 44.6 cmH2O.
- Urinary continence improved in all but one patient with self-catheterization and medication; 5 patients required adjunctive endoscopic procedures.
Conclusions:
- A prompt and standardized urological approach is mandatory for pediatric SCIs.
- The primary goals are preventing secondary upper tract damage and achieving social continence.
- Early management significantly improves bladder compliance and patient quality of life.
Purpose:
As proposed in this report, early urological rehabilitative management of patients with spinal cord injuries (SCIs) is mandatory, in order to prevent a poorly compliant bladder with related upper urinary tract complications and secondary renal failure. Moreover, the approach to treating this traumatic condition in children must be as much rapid as appropriate.
Materials And Methods:
We evaluated our experience of the last 5 years with 17 patients (12 males and five females), with a mean age of 9.6 years at injury (range 6 months-18 years), all affected by an SCI and with direct trauma involved in more than 50%. Mechanism of injury, lesional level, the mean interval between injury and bladder management onset, and the mean interval between bladder management onset and our last control were evaluated. A standardized diagnostic approach was instituted, and all patients received at least a video-urodynamic evaluation before and after the start of urological management. A continence score was established and evaluated before and at least 6 months after the application of rehabilitation treatments (catheterization, medication). Follow-up ranged from 12 to 60 months (average 29.6 months).
Results:
Sixteen of the 17 patients showed, at first urodynamic evaluation, a neurogenic overactive bladder. Mean bladder maximum capacity was 287.7 ml+/-146.4 SD. Mean reflex volume and end filling pressure were 119.7 ml+/-76.4 SD and 44.6 cmH(2)O+/-25 SD, respectively. Detrusor sphincter dyssynergia was present in 16 out of 17 of the cases. All patients but one began self-catheterization and medication (anticholinergics). Urinary continence improved in all patients but one. An adjunctive endoscopic procedure for continence was carried out in five out of 17 cases. The upper urinary tract was involved in two out of 17 cases.
Conclusions:
A prompt and standardized urological approach to pediatric SCIs is mandatory. The aims of this initial management are the prevention of further secondary damage to the upper tract and the achievement of a socially acceptable degree of urinary continence as soon as possible after the traumatic event.
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