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[Neurogenic bladder in children with acute transverse myelopathy]
V Leroy-Malherbe1, G Sébire, H Hollenberg
1Service de neuropédiatrie, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Acute transverse myelopathy often causes neurogenic sphincter dysfunction in children. Early bladder drainage for inability to void improves prognosis, while early motor recovery is also key for better outcomes.
Area of Science:
- Pediatric Neurology
- Urology
- Neuroscience
Context:
- Acute transverse myelopathy (ATM) can lead to neurogenic sphincter dysfunction in children.
- Understanding the course and management of bladder and anorectal dysfunction in pediatric ATM is crucial.
Purpose:
- To investigate the clinical course of neurogenic sphincter dysfunction in children with ATM.
- To identify prognostic factors and propose effective management strategies for bladder dysfunction in pediatric ATM.
Summary:
- This retrospective study analyzed 21 children with ATM, finding that 85% developed bladder sphincter dysfunction early on.
- Abnormal micturition perception was a consistent symptom, alongside anorectal impairment. Complete recovery occurred in 38%, with significant sequelae in 23% long-term.
- Favorable prognostic factors included early motor recovery (walking within 20 days) and timely management of bladder issues, with inability to void having a better outlook than incontinence.
Impact:
- Early, systematic bladder drainage in cases of urinary retention may be essential for improving outcomes in pediatric ATM.
- Identifying prognostic indicators aids in risk stratification and personalized treatment planning for children with ATM-related sphincter dysfunction.
Background:
Neurogenic sphincter dysfunction may result from acute transverse myelopathy. The aim of this paper is to study the course of such a dysfunction and to propose management techniques.
Patients And Methods:
The files of 21 children admitted at the mean age of 8 years 5 months (2 to 14 years, 8 months) for acute transverse myelopathy were retrospectively studied.
Results:
Bladder sphincter dysfunction occurred in the first days of disease in 85% of these patients. Abnormal perception of micturition was one of the most constant and specific symptoms. Anorectal function was also impaired. Complete regressive course was noted in 38% of patients, minor sequellae in 39% and major sequellae beyond 6 months of course in 23%. None upper tract deterioration was noted after 3 years of course. Factors of favorable prognosis were early motor function recovery (especially recommencement of walking before 20 days) and early management of bladder dysfunction (inability to void had better prognosis than urinary incontinence).
Conclusion:
Early systematic bladder drainage in case of inability to void might be essential for improved prognosis.