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[Bladder and bowel function in children with congenital spinal lipomatus malformations. A retrospective study of 114
1Unité pédiatrique de médecine physique et de réadaptation, université Pierre-et-Marie-Curie, hôpitaux universitaires Paris Est Trousseau-La Roche-Guyon, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
Insights
Children with lipomas of the conus often require neurosurgery due to neurogenic bladder. Post-surgery, specialized neuro-urology care significantly improves bladder and bowel continence in these pediatric patients.
Area of Science:
- Pediatric Urology
- Neuro-oncology
- Developmental Neurology
Context:
- Lipomas of the conus medullaris are congenital tumors impacting spinal cord development.
- Neurogenic bladder and bowel dysfunction are common complications in affected children.
- Multidisciplinary management involving neurosurgery and neuro-urology is crucial.
Purpose:
- To evaluate the impact of neurosurgery on bladder and bowel function in children with lipomas of the conus.
- To analyze pre- and post-operative continence and voiding patterns.
- To determine the effectiveness of integrated neuro-urological care.
Summary:
- A retrospective analysis of 114 children with lipomas of the conus revealed that 77 underwent neurosurgery, primarily for neurogenic bladder (60%).
- Pre-operatively, 85.7% had spontaneous micturition, with 56.3% continent. Post-operatively, continence improved to 70.1%, though spontaneous micturition decreased to 48%.
- Bowel management post-surgery showed 67.5% constipation, with 77% of treatments effective for continence.
Impact:
- Neurosurgery and specialized neuro-urology care are vital for managing bladder and bowel dysfunction in children with lipomas of the conus.
- Early and integrated management preserves renal function and improves quality of life.
- This study highlights the need for collaborative efforts between neurosurgeons, urologists, and neuro-urologists.
Objective:
To clarify bladder and bowel function of children with lipomas of the conus, without, before and after neurosurgery.
Patients And Methods:
Retrospective analysis of 114 children with a lipomas of the conus, followed in our pediatric neuro-urology department from 1993 to 2010. Several data were collected: bladder and bowel symptoms, bladder and anorectal continence, neurosurgical indication and age, clinical modification after neurosurgery, investigations carried out in pre- and post-surgery treatment, associated bladder and bowel treatment.
Results:
Forty-nine of the 77 children (63.6%) operated on had never been seen before surgery in our neuro-urology department. Seventy-seven children (67.5%) underwent a neuro-surgery, 60% indicated due to a neurogenic bladder. Before neurosurgery, 66 children (85.7%) had spontaneous miction. Five children (6.5%) had bladder intermittent catheterization. Forty of these patients (56.3%) were continent. After neurosurgery and a specialized consultation in neuro-urology, 54 children (70.1%) were continent. Thirty-seven children (48%) had spontaneous miction. Thirty-seven children (48%) had bladder intermittent catheterization and drug of overactive detrusor. Fifty-two children (67.5%) were constipated after surgery. Seventy-seven percent of the treatments for bowel symptoms were effective in terms of continence.
Conclusion:
The existence of a neurogenic bladder was one of the main indications for neurosurgery. These results suggest that the complexity of care requires neurosurgical, urological surgeon and neuro-urology physician to achieve the explorations and urinary and digestive treatment in order to preserve renal function and both continences.