During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.
Catheterization ; Catheters ; Child* ; Drug Therapy ; Follow-Up Studies ; Humans ; Replantation ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Catheterization ; Vesico-Ureteral Reflux*

During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.
Catheterization ; Catheters ; Child ; Drug Therapy ; Follow-Up Studies* ; Humans ; Replantation ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Catheterization ; Vesico-Ureteral Reflux

Current and primary treatment modality in overactive bladder includes the administration of anticholinergics. The demand for new agents has been rising since anticholinergics have proven to come with many side effects. This study was designed to investigate the effects of ylang-ylang essential oil (YYEO) on the relaxation of urinary bladder muscle in vitro and in vivo. Effects of YYEO were assessed on resting tension, and electrical field stimulation- and various drug-induced contraction in vitro by checking the isometric tension changes of muscle strips and same procedures were repeated in the presence of methylene blue, Nw-Nitro-L-arginine methyl ester hydrochloride (L-NAME), or N-ethylmaleimide, and in vivo. YYEO decreased significantly the contractility of strips. There was no statistically significant difference between the treated group only with YYEO and the pretreated group with YYEO and methylene blue or L-NAME. When N-ethylmaleimide was employed, there was a statistically significant decrease in the rate of contraction. In vivo studies showed the same results compared with in vitro study. The results of this study indicate that YYEO has a relaxing effect on the bladder, and such mechanism is thought to be brought about by a pathway mediated by c-AMP.
Animals ; *Annonaceae ; Bladder/*drug effects/physiology ; Bladder, Neurogenic/drug therapy ; Blood Pressure/drug effects ; In Vitro ; Male ; Muscle Contraction/drug effects ; Muscle, Smooth/drug effects/physiology ; Oils, Volatile/*pharmacology ; Plant Preparations/*pharmacology ; Rabbits ; Rats ; Rats, Sprague-Dawley

During a 6 year period from 1979 to 1984, we examined 35 children with neuropathic bladder At the time of their initial presentation, incontinence was the most frequent symptom (66%) and urinary tract infection was present in 63% azotemia 7% upper tract dilatation 50% vesicoureteral reflux 55% Functional classification based on urodynamical assessment and clinical findings showed 21 patients (60%) with emptying failure and 14 patients (40%) with storage failure. The incidence of upper tract dilatation and urinary tract infection was significantly higher in patients With emptying failure than those with storage failure. These patients were managed with drug therapy, intermittent catheterization and urinary diversion and their follow-up observations are discussed.
Azotemia ; Catheterization ; Catheters ; Child ; Classification ; Dilatation ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Urinary Bladder, Neurogenic* ; Urinary Diversion ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Herpes zoster is a viral infection of the dorsal nerve root causing painful vesicular eruptions over the skin or mucous membrane of the affected nerve. It is less well known to the dermatologists that berpes zoster causcs bladder dysfunction when the zoster affects the lumbar and sacral spinal ganglia. The authors observed a case of herpes zoster involving the S 2~4 dermatomes, associated with bladder atony in a 58 year old male who had received rad.iotherapy and chemotherapy for his malignant Iymphoma of lymphocytic type. Conservative treatment with urinary catheterization and antibiotics resulted in complete recovery of the bladder function about 3 weeks later. He had also ichthyosiform skin lesions on his back and lower extremities which, by carefuI history and histopathological examination, proved to be acquired ichthyosis.
Anti-Bacterial Agents ; Drug Therapy ; Ganglia, Spinal ; Herpes Zoster* ; Humans ; Ichthyosis* ; Lower Extremity ; Lymphoma* ; Male ; Middle Aged ; Mucous Membrane ; Skin ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Catheterization ; Urinary Catheters

Aminopyridines are potassium channel blockers that increase the excitability of nerve cells and axons; therefore, they are widely used to treat different neurological disorders. Here we present a patient with idiopathic downbeat nystagmus and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia who was treated with the sustained-release form of 4-aminopyridine (4-AP). During treatment with 4-AP, the LUTS improved. This improvement was monitored by using uroflowmetry and the International Prostate Symptom Score. A significant improvement of symptoms was observed in relation to the voided volume. This included an improved emptying of the bladder without an increase in residual urine. In animal studies, both nonselective K+ channel blockade and selective voltage-sensitive potassium blockade by 4-AP resulted in increased contraction on rat detrusor strips. To our knowledge, this is the first clinical observation of the mode of action of 4-AP in urological symptoms in humans.
4-Aminopyridine* ; Aminopyridines ; Animals ; Axons ; Drug Therapy ; Humans ; Lower Urinary Tract Symptoms* ; Nervous System Diseases ; Neurons ; Potassium ; Potassium Channel Blockers ; Prostate ; Prostatic Hyperplasia* ; Rats ; Urinary Bladder ; Urinary Bladder, Neurogenic

A 13-year-old boy was diagnosed as having primary nephrogenic diabetes insipidus, and symptoms developed at 3 years of age. Subsequently he developed bilateral hydronephrosis and a neurogenic bladder. His pedigree could be explored back 5 generations and represented an inheritance as an X-linked recessive transmission factor. He was treated with indomethacin 2 mg/kg/day plus chlorothiazide 500 mg/day and this new treatment showed a markedly decreased urine output and increased urine osmolarity. (Nephrogenic diabetes insipidus, Hydronephrosis, Indomethacin)
Adolescent ; Bladder, Neurogenic/etiology ; Chlorothiazide/therapeutic use ; Diabetes Insipidus/complications ; Diabetes Insipidus/congenital* ; Diabetes Insipidus/drug therapy ; Diabetes Insipidus/genetics ; Drug Therapy, Combination ; Human ; Hydronephrosis/etiology* ; Indomethacin/therapeutic use* ; Male

OBJECTIVETo evaluate the clinical efficacy of electroacupuncture (EA) combined with transperineal injection of botulinum toxin-A (BTX-A) on neurogenic bladder caused by spinal cord injury.

METHODSOne day af ter surgery, 35 cases of spinal cord injury accompanied with neurogenic bladder were randomly divided into a BTX-A plus EA group (20 cases, group A) and a BTX-A group (15 cases, group B). The two groups were both treated with regular rehabilitation training of bladder function and injection of 200 IU (4 ml) BTX-A through perineum external urethral sphincter; the group A was additionally treated with EA at Zhongji (CV 3), Guanyuan (CV 4), Shenshu (3BL 23), Huiyang (BL 35) and Baliao (Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34)), once a day, 40 min per treatment. The treatment was given 6 times per week for 4 weeks. The urination status in two groups before and after treatment was observed, and urodynamics examination and urethral pressure test were also made.

RESULTSAfter 4-week treatment, mean times of urinary incontinence, mean urethral catheter output, pressure of bladder and volume of urinary incontinence were all improved in two groups (all P<0.05), which were more significant in the group A (all P<0.05). The residual urine, maximum bladder capacity, maximum urethral closure pressure and maximum urine flow rate were all improved in two groups after treatment (all P<0.01); the improvement of residual urine, maximum bladder capacity, maximum urethral closure pressure in the group A was more significant than that in the group B (all P<0.05).

CONCLUSIONElectroacupuncture com bined with transperineal injection of BTX-A could effectively improve the urination dysfunction in patients with neurogenic bladder after spinal cord injury.

Adolescent ; Adult ; Botulinum Toxins, Type A ; administration & dosage ; Combined Modality Therapy ; Electroacupuncture ; Female ; Humans ; Injections ; Male ; Middle Aged ; Spinal Cord Injuries ; complications ; Treatment Outcome ; Urinary Bladder, Neurogenic ; drug therapy ; etiology ; physiopathology ; therapy ; Urination ; Young Adult

PURPOSE: Anticholinergics are a key element in treating neurogenic detrusor overactivity, but only limited data are available in the pediatric population, thus limiting the application to children even for oxybutynin chloride (OC), a prototype drug. This retrospective study was designed to provide data regarding the efficacy, tolerability, and safety of OC in the pediatric population (0-15 years old) with spinal dysraphism (SD). MATERIALS AND METHODS: Records relevant to OC use for neurogenic bladder were gathered and scrutinized from four specialized clinics for pediatric urology. The primary efficacy outcomes were maximal cystometric capacity (MCC) and end filling pressure (EFP). Data on tolerability, compliance, and adverse events (AEs) were also analyzed. RESULTS: Of the 121 patient records analyzed, 41 patients (34%) received OC at less than 5 years of age. The range of prescribed doses varied from 3 to 24 mg/d. The median treatment duration was 19 months (range, 0.3-111 months). Significant improvement of both primary efficacy outcomes was noted following OC treatment. MCC increased about 8% even after adjustment for age-related increases in MCC. Likewise, mean EFP was reduced from 33 to 21 cm H2O. More than 80% of patients showed compliance above 70%, and approximately 50% of patients used OC for more than 1 year. No serious AEs were reported; constipation and facial flushing consisted of the major AEs. CONCLUSIONS: OC is safe and efficacious in treating pediatric neurogenic bladder associated with SD. The drug is also tolerable and the safety profile suggests that adjustment of dosage for age may not be strictly observed.
Adolescent ; Child ; Child, Preschool ; Drug Evaluation/methods ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mandelic Acids/adverse effects/*therapeutic use ; Muscarinic Antagonists/adverse effects/*therapeutic use ; Retrospective Studies ; Spinal Dysraphism/*complications ; Treatment Outcome ; Urinary Bladder, Neurogenic/*drug therapy/etiology/physiopathology ; Urological Agents/adverse effects/*therapeutic use