Cases reported "Meningomyelocele"

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1/5. Ventriculopleural shunting used as a temporary diversion.

    Due to the limited absorptive capacity of the pleural cavity, infants and young children are not generally ideal candidates for ventriculopleural shunts. We report using chest cavities as alternate for temporary diversion of CSF in a young child. Venous access to the cervical region could not be utilized because of scarring from previous procedures, while peritoneal access was contraindicated due to repeated pseudocyst formation. Pleural effusions were removed by thoracentesis when necessary, and the shunt catheter was changed to the opposite side of the chest when the effusions reaccumulated within one week. Utilizing the ventriculopleural shunts allowed us to temporize her non-communicating hydrocephalus for a period of one year, until a definitive CSF procedure by direct intracardiac placement of the distal catheter could be performed.
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2/5. Upper urinary tract deterioration after implantation of artificial urinary sphincter.

    The preoperative urodynamic evaluations of twenty patients with myelomeningocele who had had artificial sphincter implantation because of urinary incontinence were reviewed. Four patients developed hydronephrosis and severe impairment of renal function between two and six years after implantation of the artificial sphincter. The condition was partly reversible after removal of the artificial sphincter. The urodynamic evaluation prior to implantation revealed in the four mentioned patients compared to the 16 patients with normal upper urinary tract, a tendency to lower bladder compliance, lower bladder capacity and more severe detrusor hyperreflexia, but it was not possible to make a clear discrimination between the two groups. attention is drawn to this unfortunate combination of effects after artificial sphincter implantation. Periodic control of the upper urinary tract by urography is recommended.
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3/5. Intravesical transurethral bladder stimulation to increase bladder capacity.

    Intravesical transurethral bladder stimulation is a diagnostic rehabilitative procedure that has been successful in initiating sensory-induced detrusor contractions. However, of greater significance has been the recognition that the process also will increase bladder capacity while maintaining low filling and leak pressures. Data are available on 88 patients. In 80 per cent of the children treated a greater than 50 per cent increase in bladder capacity was noted. We evaluated 46 patients who underwent long-term treatment. The beneficial effects on bladder capacity have been maintained. Exploration into whether this technique could be used, rather than augmentation procedures, is for future examination.
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4/5. Augmentation ureterocystoplasty.

    Augmentation cystoplasy using the gastrointestinal tract has disadvantages related to the intestinal resection and its incorporation into the urinary tract. To preclude both sets of complications, we performed augmentation ureterocystoplasty in a 5 1/2-year-old meningomyelocele patient with urinary incontinence, a low capacity bladder, severe vesicoureteral reflux and a poorly functioning kidney. After nephrectomy the ureter was incised longitudinally, folded over and placed onto the bladder as a patch. Bladder capacity, only 60 cc without the contribution from the refluxing upper tract, increased to 200 cc 6 months postoperatively. The patient is continent. Augmentation ureterocystoplasty is an option for bladder enlargement that obviates many of the risks associated with enterocystoplasty.
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5/5. Use of bladder stimulation in high risk patients.

    PURPOSE: We evaluated whether intravesical bladder stimulation therapy is effective in improving bladder compliance in patients with myelomeningocele, neurogenic bladder and high risk urodynamic parameters. MATERIALS AND methods: We reviewed the charts of all patients treated with bladder stimulation therapy at our institution since 1984, and identified 7 with pretreatment high risk urodynamic findings (percent expected bladder capacity 60% or less and bladder capacity pressure 50 cm. water or greater). Urodynamic and clinical data were reviewed before and after therapy. RESULTS: Following bladder stimulation in 4 of the 7 patients percent expected bladder capacity substantially increased and bladder capacity pressure decreased to safe levels. Two patients had minimal increases in percent expected bladder capacity but bladder capacity pressure decreased to 50 cm. water or less. overall percent expected bladder capacity increased from an average pretreatment value of 44% before to 65% after bladder stimulation (p < 0.05). Average bladder capacity pressure improved from 63.9 cm. water before to 32.3 cm. water after treatment (p < 0.05). Also, bladder compliance improved in all 7 patients to the point that bladder augmentation was not performed. CONCLUSIONS: Bladder stimulation is effective in improving bladder compliance in high risk patients and it may be a viable alternative to enterocystoplasty. Further long-term followup will be necessary to establish the longevity of this response.
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ranking = 8
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