Cerebral palsy, neurogenic bladder, and outcomes of lifetime care

Gillette Children's Specialty Healthcare, Lakewalk Center
Developmental Medicine & Child Neurology (Impact Factor: 3.51). 07/2012; 54(10):945-50. DOI: 10.1111/j.1469-8749.2012.04360.x
Source: PubMed


To determine the prevalence of symptomatic neurogenic bladder (SNB) and social and functional variables in a large sample of people with cerebral palsy (CP).

The medical records of 214 individuals (96 females, 118 males) with CP between the years 1990 and 2000 were retrospectively reviewed. Individuals with frequency, urgency, or incontinence were assigned Gross Motor Function Classification System levels and underwent cystometrogram/electromyelogram studies. Neurogenic bladders were classified according to the nomenclature of the International Continence Society.

Fifty-two patients had hemiplegia, 42 diplegia, 117 quadriplegia, and three dyskinesia. Educational levels ranged from full special education to those with graduate degrees. Thirty-five individuals in our group aged 5 to 66 years had SNB with a prevalence of 16.4%. The median age for the entire population was 9 years 7 months and for those with SNB 12 years 4 months (range 5-57y). Over 80% of individuals who underwent investigation were found to have spastic hyper-reflexic type bladders. Ninety-one percent obtained total continence or major improvement with conservative care. SNB was documented across the lifespan, educational spectrum, and functional level. Upper urinary tract pathology was infrequent.

SNB is a common finding in individuals with CP. In most patients it is readily diagnosed and treated with conservative interventions.

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Available from: Kevin P Murphy, Jan 10, 2015
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    ABSTRACT: This commentary is on the original article by Murphy et al. on pages 945‐950 of this issue.
    Full-text · Article · Jul 2012 · Developmental Medicine & Child Neurology
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    ABSTRACT: To assess the prevalence, type, and impact of urinary problems in adults with cerebral palsy (CP) and their relationship with Gross Motor Functional Classification Scale (GMFCS). Cross-Sectional Prospective Survey Study SETTING: Outpatient, Urban, Academic Rehabilitation Clinic PARTICIPANTS: 91 adults with cerebral palsy (45 women and 46 men) INTERVENTIONS: Subjects were approached at clinic presentation and interviewed regarding current function, type and incidence of bladder issues, and concerns with bladder problems. International Consultation on Incontinence Questionnaire-Female or - Male Lower Urinary Tract Symptoms Module, GMFCS, employment and type of residence. Mean age for both females and males was 36 years (range 18 - 79). Subjects were currently GMFCS I to V: I - 4.4 percent (%), II-19.8%, III-13.2%, IV-40.7%, and V-22.0%. 95.6% of females and 84.7% of males were living at home. Twenty-three percent were currently employed. Twenty percent of women indicated they had bladder urgency most to all of the time and 46.7% of females had leakage occurring 2-3 times per week to several times per day. In males, urgency occurring more often than "occasionally" was reported by 45.7 %, and 19.6 % reported this occurred "most to all of the time". Multivariable analyses found obese compared to normal weight was significantly related to leaking before reaching toilet (OR=4.3, CI: 1.3, 14.7), to leaking with cough, exercise or sneeze (OR=5.6, CI: 1.3, 23.1), and to nocturia (OR=5.4, CI: 1.2, 25.1). Females were more likely to leak with cough, exercise or sneeze (OR=5.5, CI: 1.5, 20.0). On scales indicating symptom interference with life, high levels of interference were reported for females with symptoms of leaking, and males with urgency and leaking. No significant differences in living situation or employment were related to incontinence scores for females or males. There are high levels of incontinence in adults with CP, and they report interference with quality of life. Despite these issues, most participants were living in the community and incontinence scores were not related to employment.
    No preview · Article · Aug 2013 · PM&R
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    ABSTRACT: A neurogenic bladder is one which functions abnormally due to disorders of sacral nerves that control the bladder's ability to fill, store and empty urine. Abnormal bladder function can cause the bladder to be underactive or overactive. This study was planned to evaluate the treatment outcome of our patients with neurogenic bladder dysfunction (NGBD). Thirty three patients who have been treated for NGBD were evaluated. Diagnosis was confirmed by voiding-cysto-urethrography (VCUG) and urodynamic study. The patients were treated medically and all had clean intermittent catheterization (CIC). Data regarding age, sex, clinical and paraclinical findings, sonography, imagings, renal scan, associated anomalies, treatment and outcomes were collected and entered in SPSS software version18 and analyzed by descriptive statistical. Findings : Totally 33 patients aged three days to four years (mean 6.8 months) were included in this study. There were 20 (61%) males and 13 (39%) females. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). Eighty two precent cases had bilatral and 18% unilatral hydronephrosis and bilatral vesicouretral reflux (VUR) existed in 67% and unilatral in 33% of the patients. Treatment consisted of antibiotherapy and CIC in all patients, which was only in 33% of the cases succesful. The most common associated anomaly was meningomyelocle in 8 patients. Vesicostomy was performed in 22 (67%) cases. Kidney scan showed scar in 10 patients at follow-up study. Complete continence on follow-up was achieved in 24 (71% ) patients, and it was improved in 6 (18% ) cases. Mortality rate was 9% (3 cases). Cure rate was 85% in urinary tract infection, 82.7% in hydronephrosis, 80% in VUR and 86.5% in kidney function. Anticholinergic medications was not effective in all our patients. We believe that permanent vesicostomy is an effective and acceptable surgical intervention for protection of upper urinary tract decompression, especially in those who do not respond to medical treatment and have high risk position.
    Full-text · Article · Jun 2014 · Iranian Journal of Pediatrics
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