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Urologischer Erkrankungen bei Patienten mit Meningomyelozele

Diagnostik und Management*

Urological problems in patients with meningomyelocele

Diagnostic studies and management*

  • Leitthema
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Zusammenfassung

Die Behandlung von Kindern und Jugendlichen mit Meningomyelozele hat in den letzten 30 Jahren einen deutlichen Wandel erfahren. Die Etablierung der Pharmakotherapie, des sauberen Einmalkatheterismus (clean intermittent catheterization, CIC) und der Infektionsprophylaxe hat die Prognose der Patienten verbessert und zu neuen therapeutischen Strategien geführt. Die interdisziplinäre Zusammenarbeit von Neonatologen, Neurochirurgen Neuropädiatern, Kinderurologen, pädiatrischen Nephrologen, Kinderorthopäden und Kinderchirurgen führt zu einer Optimierung der individuellen Therapie.

In der vorliegenden Konsensusempfehlung werden Definitionen und Klassifikationen, Untersuchungsmethoden und deren idealer Zeitpunkt dargestellt und im Einzelnen erläutert. Hierzu gehören die konservativen und operativen Therapieoptionen bei neurogener Blasenentleerungsstörung, die orthopädischen Probleme, die erhöhte Inzidenz der Latexallergie, Therapieoptionen der Darmentleerung, die Auswirkungen der neurologischen Grunderkrankung auf Sexualität und Fertilität, Diagnostik und Therapie von Harnweginfektionen sowie die Besonderheiten Patientencompliance im Verlauf.

Abstract

Since the 1980s the management of children and adolescents with meningomyelocele has undergone major changes. The introduction of pharmacotherapy with antimuscarinic agents, clean intermittent catheterization (CIC) and antibacterial prophylaxis has revolutionized the management of children with neurogenic bladder. The co-operation between neonatologists, neurosurgeons, paediatric neurologists, paediatricians, paediatric urologists, paediatric nephrologists, paediatric orthopaedists and paediatric surgeons is necessary to achieve an optimized therapy in each individual patient.

In this interdisciplinary consensus paper we provide definitions and classifications as well as a timetable for the appropriate investigations. The conservative and surgical options are explained in detail. A short review is given concerning orthopaedic management, incidence of latex allergy, options for bowel management, diagnosis and treatment of urinary tract infections, problems with sexuality and fertility as well as the long-term compliance of these patients and their relatives.

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  1. Urologische Klinik und Poliklinik, Klinikum der Johannes Gutenberg Universität, Langenbeck-Straße 1, 55131, Mainz, Deutschland

    R. Stein, A. Schröder & J.W. Thüroff

  2. Kinderklinik und Kinderpoliklinik , Klinikum der Johannes Gutenberg-Universität, Mainz, Deutschland

    R. Beetz

  3. Ermert, Mainz, Deutschland

    A. Ermert

  4. Filipas, Wiesbaden, Deutschland

    D. Filipas

  5. Urologisches Zentrum Hamburg, Hamburg-Harburg, Deutschland

    M. Fisch

  6. Klinik für Urologie und Kinderurologie, Klinikum Niederberg, Velbert, Deutschland

    M. Goepel

  7. Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Regensburg, Deutschland

    I. Körner

  8. Urologische Klinik und Poliklinik, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    B. Schönberger

  9. Urologische Abteilung, Bundeswehrkrankenhaus, Ulm, Deutschland

    C. Sparwasser

  10. Klinik und Poliklinik für Urologie, Universitätsklinikum, Essen, Deutschland

    M. Stöhrer

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  1. R. Stein
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Stein, R., Schröder, A., Beetz, R. et al. Urologischer Erkrankungen bei Patienten mit Meningomyelozele. Urologe 46, 1620–1642 (2007). https://doi.org/10.1007/s00120-007-1522-3

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