The Application of Churchill's Classification to Neurogenic Bladder in Pediatric Patients with Spina Bifida.
- Author:
Sang Wook LEE
1
;
Kwang Myung KIM
Author Information
1. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. kwang@plaza.snu.ac.kr
- Publication Type:Original Article
- Keywords:
Classification;
Neurogenic bladder;
Spinal dysraphism
- MeSH:
Child;
Classification*;
Humans;
Kidney;
Meningomyelocele;
Spinal Dysraphism*;
Urinary Bladder;
Urinary Bladder, Neurogenic*
- From:Korean Journal of Urology
2003;44(8):770-775
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This study was undertaken to ascertain if the Churchill's classification of the bladder, in children with spina bifida, reflects the characteristic clinical manifestation of the patients, and can therefore help to determine the best corrective surgical procedure in patients with spina bifida. MATERIALS AND METHODS: The patient population consisted in 148 lipomeningomyelocele and 92 meningomyelocele patients. Patient bladders were classified, according to Churchill, based on the filling, holding and voiding abnormalities(types I-V). The renal damage was expressed as grades A-D, according to the severity of the defect. RESULTS: Ninety patients were classified as type I and 5(6%) of them had renal damage. Thirty-three patients were classified as having type II and 7(21%) of them had renal damage. Five patients were classified as having type III, all with normal kidneys. Of these 5 patients, 2 received ileal augmentation and anti-incontinence surgery. 55 patients were classified as having type IV bladders and renal damage was found in 11(20%). Fifteen patients received augmentation and anti-incontinence surgery simultaneously. Two patients underwent ileal augmentation only, but incontinence continued postoperatively. Fifty-seven patients were classified as having type V bladder, and renal damage was found in 25(44%), and 15 patients received augmentation. All the type V patients that had augmentation cystoplasty maintained their continence state postoperatively. CONCLUSIONS: Neurogenic bladders in pediatric patients with spina bifida can be classified by Churchill's classification. The individual types showed characteristics of the clinical state. This classification seems to help in determining the best corrective surgical procedure in individual neurogenic bladder types of pediatric patients with spina bifida.
