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Insights
Clean intermittent catheterization is effective for managing neurogenic bladder and reflux in children. However, some cases require antireflux surgery, with the Cohen technique showing high success rates.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Background:
- Spinal dysraphism often leads to neurogenic bladder and vesicoureteral reflux.
- Intermittent catheterization is a primary treatment, with previous studies showing significant success rates in reducing reflux.
- A subset of patients, however, do not respond adequately to intermittent catheterization alone.
Purpose of the Study:
- To evaluate the outcomes of antireflux surgery in children with neurogenic bladder and persistent or high-grade vesicoureteral reflux.
- To compare the efficacy of different surgical techniques for reflux management in this patient population.
Main Methods:
- Retrospective analysis of 25 children (40 ureters) with neurogenic bladder and persistent reflux (grade IIB or higher) requiring surgery over 4 years.
- Surgical interventions included modified Leadbetter-Politano (7 ureters) and Cohen cross-trigonal techniques (33 ureters).
- Outcomes assessed included cessation of reflux and absence of obstruction.
Main Results:
- An overall success rate of 96% was achieved, defined as cessation of reflux and no obstruction.
- The Cohen cross-trigonal technique demonstrated a 100% success rate in the last 2 years, with no reported failures.
- Persistent reflux or high-grade reflux not amenable to intermittent catheterization was successfully managed surgically.
Conclusions:
- Antireflux surgery is a highly effective option for select pediatric patients with neurogenic bladder and persistent vesicoureteral reflux.
- The Cohen cross-trigonal technique is a reliable and successful surgical approach for this condition.
- A combined approach of clean intermittent catheterization and, when necessary, antireflux surgery offers optimal management for neurogenic bladder with reflux.
Abstract:
More than 75 per cent of the patients with spinal dysrhaphisms followed at our hospital are on intermittent catheterization. A previous report indicated that 62 per cent of 200 children with reflux and a neurogenic bladder either ceased to have reflux or reflux was downgraded while on intermittent catheterization and chronic antibiotics. We report on those children in whom either reflux did not stop while on the program, or who presented with high grades of reflux not amenable to cure by intermittent catheterization. During the last 4 years 25 children (40 ureters) required antireflux surgery. The criterion of repair was persistent reflux of at least grade IIB, associated with recurrent episodes of infection. A modified Leadbetter-Politano technique was used in 5 children (7 ureters) and the Cohen cross-trigonal technique was used in 20 children (33 ureters). A successful result, that is cessation of reflux and no obstruction, was achieved in 96 per cent of the patients. During the last 2 years the Cohen cross-trigonal technique has been used exclusively and there have been no failures. This successful result in 96 per cent of the children with neurogenic bladder indicates that while clean intermittent catheterization should be used primarily to relieve reflux, in a select group of children antireflux surgery should be done and clean intermittent catheterization should be continued.
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