Related Experiment Videos
The urological evaluation and management of patients with myelodysplasia
Insights
Management of myelodysplastic patients involves early surveillance and clean intermittent catheterization. This approach minimizes infections and incontinence, with surgical options for refractory cases.
Area of Science:
- Urology
- Pediatric Urology
- Neurogenic Bladder
Background:
- Myelodysplastic bladder dysfunction affects numerous children.
- Optimal management strategies are crucial for long-term outcomes.
- Previous management protocols had limitations.
Purpose of the Study:
- To present the urological evaluation and management outcomes for 183 myelodysplastic patients.
- To outline an effective management protocol for pediatric myelodysplastic bladder dysfunction.
- To assess the efficacy of clean intermittent catheterization and pharmacological interventions.
Main Methods:
- Retrospective review of 183 myelodysplastic patients' urological data.
- Implementation of a management protocol focusing on surveillance and clean intermittent catheterization (CIC).
- Pharmacological manipulation of detrusor and sphincter function.
- Urodynamic studies for complex cases.
- Surgical interventions including sphincter prosthetics and bladder augmentation.
Main Results:
- A structured management protocol led to few continence failures.
- Clean intermittent catheterization (CIC) reduced symptomatic urinary tract infections (UTIs).
- High incidence of asymptomatic bacteriuria observed despite CIC.
- Urodynamic results proved valuable in managing difficult incontinence and upper tract issues.
- Supravesical diversion showed adverse outcomes, rarely justifying its use.
Conclusions:
- A management protocol emphasizing early surveillance and CIC is effective for myelodysplastic patients.
- CIC and pharmacological treatments optimize bladder function and reduce symptomatic UTIs.
- Surgical options are available for manageable continence failures.
- Urodynamics aid in complex cases.
- Supravesical diversion is generally not recommended.
Abstract:
The urological evaluation and results of management of 183 myelodysplastic patients are presented. Our management protocol stresses upper tract and infection status surveillance during the early childhood years, and a clean intermittent catheterisation programme with pharmacological manipulation of detrusor and sphincter function as the optimal later management. Continence failures are few and are manageable by sphincter prosthetic surgery or bladder augmentation. Urodynamic results are valuable in children with difficult incontinence or poor upper tracts. The intermittent catheterisation programme reduces the incidence of symptomatic urinary infections in these patients, but the incidence of asymptomatic bacteriuria is high. The adverse results of supravesical diversion in myelodysplastic children rarely justify its use.