AA Selzman

B Albouy

GC Mingin

j Lapides

Milind Joshi

P Mollard

Sangram Singh

Vigya Chourishi

English

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Management of neurogenic bladder in myelodysplasia patients: experience at our center

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Cerebrospinal Fluid Research

ORAL PRESENTATION Open Access
Management of neurogenic bladder in
myelodysplasia patients: experience at our center
Sangram Singh*, Milind Joshi, Vigya Chourishi
From 54th Annual Meeting of the Society for Research into Hydrocephalus and Spina Bifida
Vancouver, Canada. 7-10 July 2010
Background
Myelodysplasia is the term used for lesions include
Spina bifida occulta, lipomeningocoele, meningocoele
and meningomyelocele. meningomyelocoele is by far the
most common disease of this group. These patients are
commonly having neurogenic bladder. The treatment of
neurogenic bladder is not so easy.[1] we are presenting
our experience of 68 cases with neurogenic bladders.
The aim of our study is to achieve continence and pre-
serve upper urinary tract from further damage. There
are a battery of investigations to assess these patients
for eg. renal biochemistry, ultrasonography of the urin-
ary tract, Micturating cysto-urethrogram,isotope renal
scans, Clinical and bedside assessment, and Urody-
namics.Tratment options available for these patients are
drug therapy in the form of prophylactic antibiotics and
anticholinergic drugs. Clean intermittent catheterization
advocated by Lapides plays major role in the treatment
of these patients [2]. Operative procedure perform in
these patients are bladder neck reconstructions like,
Young Dees Leadbetter and rectus sling.[3] High pres-
sure bladder can be converted to low pressure bladder
by using bladder augmentation procedures. Bladder aug-
mentation procedures are increasing bladder capacity
also thus improving dry intervals. Continent urinary
diversion can be done by using appendix [4] and seg-
ment of ileum [5]. Once these patients achieve social or
urinary continence follow up is very important.
Material and methods
We at our center in India have evaluated 68 patients of
spinal dysraphism following standard protocols. Out of
these 68 patients 45 were having urinary incontinence.
34 patients were advised CIC and oxybutynin from sec-
ond months onward. Nine patients underwent continent
urinary diversion using Mitrofanoff’s(8 patients)and
Monti’s 1 principle. Two patients underwent rectus
sling bladder neck suspension and now on CIC.
Patients who underwent continent urinary diversion
are doing well and maintaining good dry intervals. One
patient who underwent Mitrofanoff’s procedure devel-
oped post-operative necrosis of the ileal patch along with
appendix due to severe lordosis. 6 patients are totally dry,
and one patient developed post operative wound infec-
tion. The upper tract of these patients is okay, but long
term follow up will be required to draw further outcome.
Conclusions
Proper assessment and appropriate medical and surgical
intervention is must to achieve continence in neurogenic
bladder patients.
Published: 15 December 2010
References
1. Selzman AA, Elder JS, Mapstone TB: Urologic consequences of
myelodysplasias and other congenital abnormalities of the spinal cord.
Urol Clin North Am 1993, 20:485-504.
2. Lapides j, Diokno AC, Silber SM, et al: Clean intermittent self
catheterization in the treatment of urinary tract disease. J Urol 2002,
167:1584-1586.
3. Albouy B, Grise P, Sambuis C, et al: Evaluation of bladder wall wraparound
sling procedure. J Urol 2001, 177:716-719.
4. Mollard P, Gauriau L, Bonnet JP, et al: Continent cystostomy (Mitrofanoff’s
procedure) for neurogenic bladder in children and adolescents (56 cases:
long-term results). Eur J Pediatr Surg 1997, 7:34-7.
5. Mingin GC, Baskin LS: Surgical management of the neurogenic bladder
and bowel. Pediatr Urol 2003, 29:53-61.
doi:10.1186/1743-8454-7-S1-S8
Cite this article as: Singh et al.: Management of neurogenic bladder in
myelodysplasia patients: experience at our center. Cerebrospinal Fluid
Research 2010 7(Suppl 1):S8.* Correspondence: drsangramsingh@gmail.com
Department of Pediatric Surgery, Sri Aurobindo Institute of Medical Sciences,
Indore. M.P, India
Singh et al. Cerebrospinal Fluid Research 2010, 7(Suppl 1):S8
http://www.cerebrospinalfluidresearch.com/content/7/S1/S8
CEREBROSPINAL FLUID RESEARCH
© 2010 Singh et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Chourishi Vigya

Joshi Milind

Singh Sangram

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al: Continent cystostomy (Mitrofanoff’s procedure) for neurogenic bladder in children and adolescents (56 cases: long-term results). Eur J Pediatr Surg

Clean intermittent self catheterization in the treatment of urinary tract disease.

et al: Evaluation of bladder wall wraparound sling procedure.

LS: Surgical management of the neurogenic bladder and bowel. Pediatr Urol

TB: Urologic consequences of myelodysplasias and other congenital abnormalities of the spinal cord. Urol Clin North Am

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Management of neurogenic bladder in myelodysplasia patients: experience at our center

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