Severe bladder dysfunction revealed prenatally or during infancy |
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| Authors: | Isabelle Vidal Yves Héloury Philippe Ravasse Loic Lenormand Marc-David Leclair |
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| Institution: | 1. Paediatric Urology and Surgery Department, Service de Chirurgie Infantile, Hôpital Mère-Enfant, CHU de NANTES, F-44 093 Nantes Cedex, France;2. Paediatric Surgery Department, CAEN, France;3. Urodynamic Unit, Adult Urology Department, NANTES, France;1. Pediatric Uronephrologic Center, The Queen Silvia Children''s Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;2. The Children''s Memorial Health Institute, Warsaw, Poland;1. Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota;8. Clinical Enteric Neurosciences Translational and Epidemiology Research Program, Mayo Clinic, Rochester, Minnesota;3. Department of Medicine, Wayne State University, Detroit, Michigan;4. Department of Medicine, Hopital General Douala, Douala, Cameroon;6. Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut;5. Department of Medicine, St Mary Mercy Hospital, Livonia, Michigan;7. Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan;12. Department of Medicine, Wright University, Dayton, Ohio;1. School of Nursing, China Medical University, Shenyang 110122, China;2. Health Management Center, General Hospital of Northern Theater Command, Shenyang 110003, China;1. Department of Paediatric Surgery, St George''s Healthcare NHS Trust, London, UK;2. Great Ormond Street Hospital for Children, Great Ormond Street, London, UK;1. Department of Paediatric Surgery, Queen Silvia Children''s Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;2. The Paediatric UroNephrologic Centre, Queen Silvia Children''s Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden |
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| Abstract: | ObjectiveAlthough thought to be an acquired condition, non-neurogenic neurogenic bladder may sometimes be a congenital dysfunction, revealed before toilet training. We report our experience with the condition diagnosed prenatally or during early infancy.Patients and methodWe retrospectively reviewed cases of severe bladder dysfunction with upper-tract impairment, without neurological or obstructive pathology, in children diagnosed before toilet training: five with prenatal diagnosis of severe hydro-ureteronephrosis (group 1) and six with signs of bladder dysfunction during infancy (group 2).ResultsFollow up of group 1 showed decompensation toward severe bladder dysfunction, diagnosed after either toilet training or ureteral reimplantation (n = 3). After a median follow up of 14 years (0.5–20), four were on clean intermittent catheterization with bladder augmentation and one required sphincteric re-education with good result. Two of the five had chronic renal failure. In group 2, six children (two females) presented at median age of 20 months (2–30) with indirect signs of bladder dysfunction, including vesicoureteral reflux (n = 4) and/or hydro-ureteronephrosis (n = 4). After a median follow up of 11 years (5–20), three were on clean intermittent catheterization (two Mitrofanoff channels), and three underwent bladder augmentation. Three children had chronic renal failure of whom one underwent renal transplant.ConclusionThese cases of severe bladder dysfunction were initially misdiagnosed. In both groups, follow up revealed severe dilatation of the upper tract and secondary renal impairment. Antenatal diagnosis of bilateral pyeloureteral dilatation may be the first sign of early bladder dysfunction. |
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