1/35. An unexpected complicationof the remote-controlled intraurethral valve pump for urinary incontinence.We report an unexpected complication of the remote-controlled intraurethral valve pump in a patient with neurogenic bladder. A meningomyelocele patient with an atonic bladder received an intraurethral valve pump. Acute urinary retention was caused by a mucus clot obstructing the pump. Prior to extended clinical use, the remote-controlled intraurethral valve pump should be evaluated in prospective multicenter studies.- - - - - - - - - - ranking = 1keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
2/35. Segmental costovertebral malformations: association with neural tube defects. Report of 3 cases and review of the literature.patients with spondylocostal dysostosis (SCD) have vertebral abnormalities and numerical or structural rib anomalies that produce thoracic asymmetry. Rib anomalies and dysmorphism are the typical features that differentiate this syndrome from spondylothoracic dysostosis (STD). Jarcho-Levin syndrome is a severe form with involvement of the whole vertebral column. Other associated findings such as congenital heart defects, abdominal wall malformations, genitourinary malformations and upper limb anomalies may be found; in addition, neural tube defects (NTDs) have been associated with this malformation. SCD is transmitted both in a recessive form and as a dominant defect. We report on 3 children with SCD; 2 also had NTDs. All of them were studied with x-rays and spinal magnetic resonance (MR), and over the same period they underwent multidisciplinary clinical functional evaluation. One of our cases with NTD also presented polythelia, which has not previously been described in patients with SCD. The common association of segmental costovertebral malformations with NTDs could be related to an early gastrulation genomic defect, or one after gastrulation, when there are two independent somitic columns. The latter sometimes progresses and then involves primary and secondary neurulation. Also, the association of SCD with NTDs could be related to the interaction of different genes, resulting in this complex phenotype. Therefore, additional genetical and embryological studies are necessary to provide evidence of an etiological link between SCD and NTD.- - - - - - - - - - ranking = 0.0024930858878392keywords = urinary (Clic here for more details about this article) |
3/35. Vesicostomy in adult meningomyelocele patients. Reappraisal of an old technique.Intermittent catheterization is the standard treatment of neurogenic bladder dysfunction. In adult meningomyelocele patients, self-catheterization is not always possible or is not accepted. In these patients, urinary diversion is frequently hampered by anatomical abnormalities, preventing the use of bowel. Vesicostomy as a safe procedure in selected adult patients was employed at our department.- - - - - - - - - - ranking = 0.0024930858878392keywords = urinary (Clic here for more details about this article) |
4/35. Partial caudal duplication in a newborn associated with meningomyelocele and complex heart anomaly.BACKGROUND: Caudal duplication is a spectrum of rare congenital anomalies with a possible heterogeneous pathogenesis including incomplete separation of monovular twins. methods: We report an autopsy case of a full-term infant with incomplete caudal duplication syndrome associated with multiple anomalies. RESULTS: These anomalies included a duplicated penis; double urinary bladder with an attenuated tunica muscularis; duplication of lower bowel with two ilia, appendices and colons; colonic hypogangliosis and left imperforated anus associated with rectourethral fistula. Other anomalies consisted of sacral meningomyelocele, sacral duplication with hypoplastic left sacrum and pelvic bones, muscle atrophy and hypoplasia of the left lower extremity, abnormal lobation of liver with stomach entrapment, omphalocele, and right atrial isomerism syndrome. The complex pattern of anomalies suggests the possibility that partial caudal duplication might be part of the spectrum of conjoined twinning.- - - - - - - - - - ranking = 0.0024930858878392keywords = urinary (Clic here for more details about this article) |
5/35. Cecal volvulus: a report of two cases occurring after the antegrade colonic enema procedure.BACKGROUND: Many children with chronic constipation and fecal incontinence have benefited from the antegrade colonic enema (ACE) procedure. Routine antegrade colonic lavage often allows such children to avoid daytime soiling. This report describes 2 children in whom the ACE procedure was complicated by a cecal volvulus. methods: A retrospective review of 164 children with an ACE procedure was conducted. Two instances of cecal volvulus were identified. RESULTS: The first child presented with abdominal pain and difficulty intubating the ACE site. Over the subsequent day, his pain worsened, and radiographs depicted a colonic obstruction. At laparotomy, a cecal volvulus resulting in bowel necrosis was observed, and resection of the affected bowel and appendix (in the right lower quadrant) and end ileostomy was required. He subsequently had the stoma closed and a new ACE constructed with a colon flap. The second child presented with shock and evidence of an acute abdomen. At laparotomy, a cecal volvulus was noted, and ileocolic resection including the ACE stoma (located at the umbilicus) and an ileostomy and Hartmann pouch was performed. He had a protracted hospital course requiring ventilator and inotropic support. He currently is well and still has an ileostomy stoma. CONCLUSIONS: A high index of suspicion for a potentially life-threatening cecal volvulus should be maintained in children undergoing an ACE procedure who present with abdominal pain, evidence of bowel obstruction, or difficulty in advancing the ACE irrigation catheter.- - - - - - - - - - ranking = 0.069817355143813keywords = incontinence (Clic here for more details about this article) |
6/35. Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts.Routine urological evaluation of children with myelomeningocele helps to identify those at risk for upper urinary tract deterioration. We report on 2 patients with ventriculoperitoneal shunts who had intraperitoneal rupture of the bladder. Reflux of contrast media via or around the ventriculoperitoneal shunt into the cerebral ventricles occurred in both patients, resulting in severe neurological insult.- - - - - - - - - - ranking = 0.012465429439196keywords = urinary (Clic here for more details about this article) |
7/35. Giant terminal lipomyelocystocele.Terminal myelocystocele is a rare form of occult spinal dysraphism in which the hydromyelic caudal spinal cord and the subarachnoid space are herniated through a posterior spina bifida. A 1-year-old female child presented with a large lumbosacral mass (30 x 20 x 10 cm), flaccid paraplegia and urinary incontinence since birth. magnetic resonance imaging revealed a low-lying conus (with associated conus lipoma) and a dilated central canal surrounded by a meningocele suggestive of terminal lipomyelocystocele and was operated on successfully. In our experience, this was a giant terminal lipomyelocystocele and such a large lesion has not been reported in the literature before. Terminal myelocystocele should be included in the differential diagnosis of congenital lesions presenting as a lumbosacral mass and operated early.- - - - - - - - - - ranking = 0.24937672852804keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
8/35. Thoracic myelocystoceles--two variants.Myelocystoceles are rare lesions. Rarer still are thoracic myelocystoceles. Two patients with thoracic myelocystoceles are being reported. The first patient presented with swelling in the thoracic region with paraplegia and incontinence. MR with MR myelography revealed the malformation to be a thoracic myelocystocele. The second patient presented with a midline cutaneous mass lesion without neurological deficit. MRI revealed a Type I split cord malformation, a CSF containing sac in the thoracic region that communicated through a stalk-like structure to the hydromyelic hemicord. Surgery in both these patients did not produce any change in the neurological status. The importance of recognizing thoracic myelocystoceles, their clinical presentation, embryology, value of MR myelography in the diagnosis and role of surgery are discussed. The differences between terminal myelocystoceles and thoracic myelocystoceles are also highlighted.- - - - - - - - - - ranking = 0.069817355143813keywords = incontinence (Clic here for more details about this article) |
9/35. Gracilis muscle transposition for anal incontinence in children: long-term follow-up.We report a series of 7 patients, aged 6.5 to 19 years (mean, 12.9), who have been treated for uncontrollable fecal incontinence since 1976: 5 had imperforate anus and multiple subsequent operative procedures, 1 had a low myelomeningocele with bi-sphincteric incontinence, and 1 had a traumatic destruction of the sphincter apparatus. A modified Pickrell procedure was performed, with the gracilis muscle transposed subcutaneously, without constructing a pulley through the median raphe as originally described. All patients were evaluated by anorectal manometry preoperatively and post-operatively. They were followed-up for a period of 0.5 to 12.5 years (mean, 4.4). All patients were continent at follow-up, with a normal defecation pattern and no enemas required. None of the patients had evidence of fibrosis of the muscle or anal canal, and tension in the transposed muscle was maintained. Voluntary contractions remain efficient in all cases. Age was thought to be an important factor: personal motivation and compliance with physiotherapy, essential for a good outcome, is unlikely to be present in the younger child. We conclude that the gracilis sling procedure is an excellent long-term alternative for total fecal incontinence when time and other therapeutic measures have failed.- - - - - - - - - - ranking = 0.48872148600669keywords = incontinence (Clic here for more details about this article) |
10/35. Neuroprostheses in the management of incontinence in myelomeningocele patients.A 16-year-old boy and a 17-year-old girl underwent successful closure of the meningomyelocele defect in childhood but they continued to suffer incontinence of stool and urine. After a 5-day trial with percutaneous electrostimulation of the pudendal nerve both patients received permanent neuroprosthetic implants. They became completely continent of stool and exhibited greater than 90% improvement in urinary control. These patients demonstrate that there is a small subset of meningomyelocele patients who, despite absence of spontaneous reflex tonus in the urinary and bowel sphincters, nevertheless have preserved motor capabilities.- - - - - - - - - - ranking = 0.35407294749474keywords = incontinence, urinary (Clic here for more details about this article) |
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