R Vereecken

Publications (5)12.87 Total impact

• Article: Intravesical application of a stable oxybutynin solution improves therapeutic compliance and acceptance in children with neurogenic bladder dysfunction.

  G Buyse, C Verpoorten, R Vereecken, P Casaer
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  ABSTRACT: To improve patient compliance with and acceptance of intravesical oxybutynin therapy for neurogenic bladder dysfunction we developed a stable oxybutynin solution that eliminates the complicated crushing procedure. From January 1995 to January 1997 we prospectively evaluated 15 children with a mean age of 6.1 years with persistent detrusor hyperactivity or significant side effects on oral oxybutynin therapy who received intravesically 0.2 mg./kg. (maximum 5 mg.) of a stable oxybutynin solution (5 mg./5 ml., pH 5.85) twice daily. The oxybutynin solution remained stable up to 24 months. In 13 of the 15 children therapeutic compliance was excellent. Detrusor hyperactivity decreased and systemic side effects were absent or minimal. After 4 and 24 months mean cystometric bladder capacity plus or minus standard error of mean increased from 114+/-15.2 to 161+/-26.6 and 214+/-21.7 ml. (p <0.01), mean ratio of cystometric-to-expected bladder capacity increased from 0.88+/-0.12 to 1.18+/-0.14 and 1.24+/-0.16 (p <0.01), and end filling bladder pressure decreased from 57.0+/-7.1 to 25.6+/-4.4 and 30.8+/-4.4 cm. water (p <0.01), respectively. Intravesical instillation of a specially prepared oxybutynin solution is safe and reliable in children with persistent detrusor hyperactivity or side effects on oral oxybutynin therapy. Eliminating the complex crushing preparation of the solution by the child or parent has made this therapy easy to use and acceptable in the long term.
  The Journal of Urology 10/1998; 160(3 Pt 2):1084-7; discussion 1092. · 3.75 Impact Factor
• Article: Tethered cord syndrome in occult spinal dysraphism: timing and outcome of surgical release.

  L Cornette, C Verpoorten, L Lagae, F Van Calenbergh, C Plets, R Vereecken, P Casaer
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  ABSTRACT: To investigate the influence of neurosurgical intervention on the appearance of upper motor neuron (UMN) signs in newborns diagnosed with occult spinal dysraphism and tethered cord (TC) during the first month of life. A prospective study (1990 to 1996) of 22 consecutive newborns with occult spinal dysraphism monitored for the appearance of UMN signs. Untethering was performed when neurologic or urodynamic investigation indicated the presence of UMN dysfunction. Of 22 patients, 10 remained free of UMN symptoms during follow-up (mean, 67+/-22 months). Untethering was performed in 12 of 22 patients because of the presence of UMN symptoms. In 7 of these 12 patients, there was a documented asymptomatic period of 13+/-11 months before the onset of UMN symptoms. Untethering at a mean age of 18+/-17 months restored normal neurologic and urinary function in all patients (mean postoperative follow-up, 25+/-16 months). Of the 12 children, 5 presented with UMN signs at birth. In these children, untethering was performed at a mean age of 9+/-5 months. In two of these five patients, UMN symptoms did not resolve after surgery, and ongoing conservative bladder treatment was required (mean follow-up, 37+/-14 months). In none of the 12 operated children did signs of retethering occur. A significant number (10/22) of children born with occult spinal dysraphism and TC did not develop UMN symptoms during follow-up; neurosurgical correction after the appearance of an UMN sign restored normal neurologic and urinary function in all children; and untethering in children presenting at birth with UMN symptoms resulted in poorer outcome.
  Neurology 07/1998; 50(6):1761-5. · 8.31 Impact Factor
• Article: Treatment of neurogenic bladder dysfunction in infants and children with neurospinal dysraphism with clean intermittent (self)catheterisation and optimized intravesical oxybutynin hydrochloride therapy.

  G Buyse, C Verpoorten, R Vereecken, P Casaer
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  ABSTRACT: Clean intermittent (self)catheterisation (CIC) in combination with oral anticholinergic drugs (oxybutynin hydrochloride [OH] is the present standard therapy for neurogenic bladder dysfunction (NBD) with detrusor hyperactivity. However, complete suppression of detrusor contractions and complete urinary continence is not always obtained despite maximal dosage, and the high incidence of severe systemic anticholinergic side-effects often impairs therapeutic compliance, resulting in dose reduction or even discontinuation of therapy. The intravesical administration of OH has been shown recently to be an effective alternative for treating persistent detrusor hyperactivity, and occurrence and severity of systemic side-effects appeared to be significantly decreased. However, available data are limited from a paediatric view. Furthermore, it is our belief that the use of crushed OH tablets with consequent problems of impracticability accounts for the variable long-term patient compliance reported to be the only disadvantage to intravesical OH. Using an optimized drug preparation we demonstrate the superiority of intravesical OH for treatment of NBD in 15 children (range 0.6-13.75 years, mean 6.1) with incomplete detrusor activity suppression and/or intolerable systemic side-effects on oral OH therapy. Since the previous reported problems of impracticability and variable long-term patient compliance can be resolved by optimized drug preparation, we therefore conclude that the era of crushing OH tablets should be over in order to allow the intravesical OH therapy on a long-lasting and large-scale basis.
  European Journal of Pediatric Surgery 01/1996; 5 Suppl 1:31-4. · 0.81 Impact Factor
• Article: Conservative versus neurosurgical treatment of tethered cord patients.

  L Lagae, C Verpoorten, P Casaer, R Vereecken, G Fabry, C Plets
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  ABSTRACT: We compared the outcome of neurosurgical release of a tethered spinal cord in 20 children with the neurological evolution of 21 other children known iwth a tethered spinal cord on nuclear magnetic resonance scan (NMR). Neurosurgery yielded stabilisation of the symptoms without any lasting improvement. Pre-operative conservative medical treatment had to be continued in all operated children. Three of the 20 operated children are showing signs of retethering despite appropriate neurosurgery, indicating that retethering should be considered as a major and frequent complication. In the majority of our children, symptomatic (re)tethering was recognised by the appearance of increased tendon reflexes and a progressive pes cavus, suggestive of an upper motor neuron disease involvement.
  Zeitschrift für Kinderchirurgie: organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood 01/1991; 45 Suppl 1:16-7.
• Article: Electromyography of the external anal sphincter muscle during urodynamic testing in children with meningomyelocele.

  M Lissens, J P Van de Walle, R Vereecken, F Bruyninckx, N Rosselle
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  ABSTRACT: In this study the correlation between the electromyographic examination of the external sphincter muscle and the urodynamic findings in patients with meningomyelocele was evaluated. Urodynamic testing, consisting of cystometry with bladder, urethral and abdominal pressure monitoring was performed with simultaneous electromyography of the external and sphincter muscle in 61 children, 29 boys and 32 girls, divided in groups according to age and to the level of lesion. Normal urodynamic studies were always correlated with normal external sphincter electromyography. In all patients with a high lesion and in 79% of all others detrusor hyperactivity was correlated with pathological sphincter electromyography. The clinical neurological level of the lesion was not correlated with the function of the detrusor-sphincter mechanism. In 29% of the patients examined with needle electromyography detrusor-sphincter dyssynergia was found, which is less than in most other published studies. And although dyssynergia is a risk factor for renal deterioration, the authors conclude that its effect on the ureter is less important than in subjects with normal perineal musculature, since 80% of the examined patients with meningomyelocele showed pathological sphincter electromyography. These findings thus show a significant correlation between electromyography of the external sphincter muscle and the urodynamic findings in meningomyelocele patients, and clearly demonstrate the importance of urodynamic testing with simultaneous external sphincter electromyography, in order to improve both diagnostic accuracy and reliability of follow-up and treatment.
  Acta Belgica. Medica physica: organe officiel de la Société royale belge de médecine physique et de réhabilitation 13(4):167-73.