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The urological management of children with spinal cord injury

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Abstract

Background

The urologic management of children with spinal cord injury (SCI) differs from that of the adult insofar as the care involves a developing organ system and will be ongoing for years. Preservation of renal function as well as prevention of urinary tract infection in concert with both bladder and bowel continence are the essential guiding principles.

Methods

This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on special considerations in children with spinal cord injuries.

Results

SCI in children is less frequent than in adults and affects mainly older children and teenagers. The etiology of SCI in children is usually motor vehicle accidents. The cervical spine is often injured. The urologic evaluation is similar to that for adults but may involve more frequent radiologic and urodynamic assessment to monitor renal function as the child grows.

Conclusions

Treatment may be divided into medical vs. surgical and mirrors the approach to children who have a neurogenic bladder due to spina bifida. Bladder management should be associated with bowel management to achieve the goals of continence and social acceptability.

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References

  1. Noonan VK, Fingas M, Farry A et al (2012) Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology 38(4):219–226

    Article  PubMed  Google Scholar 

  2. Parent S, Dimar J, Dekutoski M, Roy-Beaudry M (2010) Unique features of pediatric spinal cord injury. Spine 35(21 Suppl):S202–S208

    Article  PubMed  Google Scholar 

  3. Saunders LL, Selassie A, Cao Y et al (2015) Epidemiology of pediatric spinal cord injury in a population-based cohort, 1998–2012. Top Spinal Cord Inj Rehabil 21(4):325–332

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kirshblum S, Campagnolo D (2011) Spinal cord medicine. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  5. DeVivo MJ, Black KJ, Stover SL (1993) Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil 74(3):248–254

    CAS  PubMed  Google Scholar 

  6. Soden RJ, Walsh J, Middleton JW et al (2000) Causes of death after spinal cord injury. Spinal Cord 38(10):604–610

    Article  CAS  PubMed  Google Scholar 

  7. Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 trauma center. J Pediatr Surg 36(8):1107–1114

    Article  CAS  PubMed  Google Scholar 

  8. Cirak B, Ziegfeld S, Knight VM et al (2004) Spinal injuries in children. J Pediatr Surg 39(4):607–612

    Article  PubMed  Google Scholar 

  9. Pannek J, Diederichs W, Botel U (1997) Urodynamically controlled management of spinal cord injury in children. Neurourol Urodyn 16(4):285–292

    Article  CAS  PubMed  Google Scholar 

  10. Bauer SB, Austin PF, Rawashdeh YF et al (2012) International children’s continence society’s recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 31(5):610–614

    Article  PubMed  Google Scholar 

  11. Ditunno JF, Little JW, Tessler A, Burns AS (2004) Spinal shock revisited: a four-phase model. Spinal Cord 42(7):383–395

    Article  CAS  PubMed  Google Scholar 

  12. Srivastava RN (2010) Paper 191: duration of spinal shock in spinal cord injuries. In: Orthopedic proceedings

  13. Koff SA (1983) Estimating bladder capacity in children. Urology 21(3):248–251

    Article  CAS  PubMed  Google Scholar 

  14. Chao R, Mayo ME (1994) Long-term urodynamic follow up in pediatric spinal cord injury. Paraplegia 32(12):806–809

    CAS  PubMed  Google Scholar 

  15. Fanciullacci F, Zanollo A, Sandri S, Catanzaro F (1988) The neuropathic bladder in children with spinal cord injury. Paraplegia 26:83–86

    CAS  PubMed  Google Scholar 

  16. Generao SE, Dall’era JP, Stone AR, Kurzrock EA (2004) Spinal cord injury in children: long-term urodynamic and urological outcomes. J Urol 172(3):1092–1094 (discussion 1094)

    Article  PubMed  Google Scholar 

  17. Sekar P, Wallace DD, Waites KB et al (1997) Comparison of long-term renal function after spinal cord injury using different urinary management methods. Arch Phys Med Rehabil 78(9):992–997

    Article  CAS  PubMed  Google Scholar 

  18. Welk B, Fuller A, Razvi H, Denstedt J (2012) Renal stone disease in spinal-cord-injured patients. J Endourol 26(8):954–959

    Article  PubMed  Google Scholar 

  19. Husmann DA (2009) Malignancy after gastrointestinal augmentation in childhood. Ther Adv Urol 1(1):5–11

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gurung PM, Attar KH, Abdul-Rahman A et al (2012) Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up. BJU Int 109(8):1236–1242

    Article  PubMed  Google Scholar 

  21. Hornyak JE, Wheaton MW, Nelson VS (2010) Spinal cord injuries. In: Alexander MA, Matthews DJ (eds) Pediatric rehabilitation: principles and practice, 5th edn. Demos Medical Publishing, New York, pp 412–428

    Google Scholar 

  22. Sahai A, Cortes E, Seth J et al (2011) Neurogenic detrusor overactivity in patients with spinal cord injury: evaluation and management. Curr Urol Rep 12(6):404–412

    Article  PubMed  Google Scholar 

  23. Linsenmeyer TA, Bodner DR, Creasey GH et al (2006) Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med 29(5):527–573

    Google Scholar 

  24. Schlager TA, Clark M, Anderson S (2001) Effect of a single-use sterile catheter for each void on the frequency of bacteriuria in children with neurogenic bladder on intermittent catheterization for bladder emptying. Pediatrics 108(4):E71

    Article  CAS  PubMed  Google Scholar 

  25. Lee B, Featherstone N, Nagappan P et al (2016) British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder. J Pediatr Urol 12(2):76–87

    Article  CAS  PubMed  Google Scholar 

  26. Williams G, Craig JC (2011) Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev 3:CD001534

    Google Scholar 

  27. Ottolini MC, Shaer CM, Rushton HG et al (1995) Relationship of asymptomatic bacteriuria and renal scarring in children with neuropathic bladders who are practicing clean intermittent catheterization. J Pediatr 127(3):368–372

    Article  CAS  PubMed  Google Scholar 

  28. Clarke SA, Samuel M, Boddy SA (2005) Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. J Pediatr Surg 40(3):568–571

    Article  PubMed  Google Scholar 

  29. Everaert K, Lumen N, Kerckhaert W et al (2009) Urinary tract infections in spinal cord injury: prevention and treatment guidelines. Acta Clin Belg 64(4):335–340

    Article  CAS  PubMed  Google Scholar 

  30. Barbalias GA, Klauber GT, Blaivas JG (1983) Critical evaluation of the Credé Maneuver: a urodynamic study of 207 patients. J Urol 130(4):720–723

    Article  CAS  PubMed  Google Scholar 

  31. Pruitt D, McMahon M (2016) Spinal cord injury and autonomic crisis management. In: Kliegman RM, Stanton BM, St. Geme J, Schor NF (eds) Nelson textbook of pediatrics, 20th edn. Elsevier, Philadelphia, pp 3400–3403

    Google Scholar 

  32. McGinnis KB, Vogel LC, McDonald CM et al (2004) Recognition and management of autonomic dysreflexia in pediatric spinal cord injury. J Spinal Cord Med 27(Suppl 1):S61–S74

    Article  PubMed  Google Scholar 

  33. Hickey KJ, Vogel LC, Willis KM et al (2004) Prevalence and etiology of autonomic dysreflexia in children with spinal cord injuries. J Spinal Cord Med 27(Suppl 1):S54–S60

    Article  PubMed  Google Scholar 

  34. Canon S, Shera A, Phan NM et al (2015) Autonomic dysreflexia during urodynamics in children and adolescents with spinal cord injury or severe neurologic disease. J Pediatr Urol 11(1):32.e1–32.e4

    Article  Google Scholar 

  35. Kroll P, Gajewska E, Zachwieja J et al (2016) An evaluation of the efficacy of selective alpha-blockers in the treatment of children with neurogenic bladder dysfunction—preliminary findings. Int J Environ Res Public Health 13(3):321

    Article  CAS  PubMed Central  Google Scholar 

  36. Verpoorten C, Buyse GM (2008) The neurogenic bladder: medical treatment. Pediatr Nephrol 23(5):717–725

    Article  PubMed  Google Scholar 

  37. Diokno AC, Apell RA, Sand PK et al (2003) Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc 78(6):687–695

    Article  CAS  PubMed  Google Scholar 

  38. Zinner N, Tuttle J, Marks L (2005) Efficacy and tolerability of darifenacin, a muscarinic M3 selective receptor antagonist (M3 SRA), compared with oxybutynin in the treatment of patients with overactive bladder. World J Urol 23(4):248–252

    Article  CAS  PubMed  Google Scholar 

  39. Cardozo L, Lisec M, Millard R et al (2004) Randomized, double-blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. J Urol 172(5 Pt 1):1919–1924

    Article  CAS  PubMed  Google Scholar 

  40. Baigrie RJ, Kelleher JP, Fawcett D, Pengelly AW (1988) Oxybutinin: is it safe? Br J Urol 62(4):319–322

    Article  CAS  PubMed  Google Scholar 

  41. Blais AS, Nadeau G, Moore K et al (2016) Prospective pilot study of mirabegron in pediatric patients with overactive bladder. Eur Urol 70(1):9–13

    Article  PubMed  Google Scholar 

  42. Duckett JJ (1974) Cutaneous vesicostomy in childhood. The Blocksom technique. Urol Clin North Am 1(3):485–495

    PubMed  Google Scholar 

  43. Krahn C, Johnson H (1993) Cutaneous vesicostomy in the young child: indications and results. Urology 41(6):558–563

    Article  CAS  PubMed  Google Scholar 

  44. Morrisroe S, O’Connor R, Nanigian D et al (2005) Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children? BJU Int 96(3):397–400

    Article  PubMed  Google Scholar 

  45. Hutcheson J, Cooper C, Canning D et al (2001) The use of vesicostomy as permanent urinary diversion in the child with myelomeningocele. J Urol 166(6):2351–2353

    Article  CAS  PubMed  Google Scholar 

  46. Hill V, Davies W (1988) A swing to intermittent clean self-catheterisation as a preferred mode of management of the neuropathic bladder for the dextrous spinal cord patient. Paraplegia 26(6):405–412

    CAS  PubMed  Google Scholar 

  47. Mansoor S, Ayaz S, Rathore F, New P (2016) Longitudinal cleavage of the penis in chronic spinal cord injury: two case reports. J Spinal Cord Med 39(3):366–369

    Article  PubMed  PubMed Central  Google Scholar 

  48. Jamison J, Maguire S, McCann J (2013) Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders. Cochrane Database Syst Rev 11:CD004375

    Google Scholar 

  49. Vaidyanathan S, Mansour P, Soni B et al (2002) The method of bladder drainage in spinal cord injury patients may influence the histological changes in the mucosa of neuropathic bladder—a hypothesis. BMC Urol 2:5

    Article  PubMed  PubMed Central  Google Scholar 

  50. Welk B, McIntyre A, Teasell R et al (2013) Bladder cancer in individuals with spinal cord injuries. Spinal Cord 51(7):516–521

    Article  CAS  PubMed  Google Scholar 

  51. Lee W, Sun L, Lin C et al (2014) Risk of prostate and bladder cancers in patients with spinal cord injury: a population-based cohort study. Urol Oncol 32(1):51.e1–51.e7

    Article  Google Scholar 

  52. Nahm L, Chen Y, DeVivo M, Lloyd L (2015) Bladder cancer mortality after spinal cord injury over 4 decades. J Urol 193(6):1923–1928

    Article  PubMed  Google Scholar 

  53. Bauman T, Potretzke T, Potretzke A et al (2015) Mucinous adenocarcinoma of the bladder associated with long term suprapubic tube: a case report. BMC Urol 15:119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. de Badiola F, Denes E, Ruiz E et al (1996) New application of the gastrostomy button for clinical and urodynamic evaluation before vesicostomy closure. J Urol 156(2 Pt 2):618–620

    Article  PubMed  Google Scholar 

  55. Bradshaw CJ, Gray R, Downer A, Hitchcock R (2014) Button vesicostomy: 13 years of experience. J Pediatr Urol 10(1):80–87

    Article  PubMed  Google Scholar 

  56. Ching C, Stephany H, Juliano T et al (2014) Outcomes of incontinent ileovesicostomy in the pediatric patient. J Urol 191(2):445–450

    Article  PubMed  Google Scholar 

  57. Schwarz G, Jeffs R (1975) Ileal conduit urinary diversion in children: computer analysis of followup from 2 to 16 years. J Urol 114(2):285–288

    Article  CAS  PubMed  Google Scholar 

  58. Shapiro S, Lebowitz R, Colodny A (1975) Fate of 90 children with ileal conduit urinary diversion a decade later: analysis of complications, pyelography, renal function and bacteriology. J Urol 114(2):289–295

    Article  CAS  PubMed  Google Scholar 

  59. Stein R, Wiesner C, Beetz R et al (2005) Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part III: colonic conduit. Pediatr Nephrol 20(7):932–936

    Article  PubMed  Google Scholar 

  60. Akbar M, Abel R, Seyler T et al (2007) Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction. BJU Int 100(3):639–645

    Article  PubMed  Google Scholar 

  61. Horst M, Weber D, Bodmer C, Gobet R (2011) Repeated botulinum-A toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele. Neurourol Urodyn 30(8):1546–1549

    Article  CAS  PubMed  Google Scholar 

  62. Khan M, Van der Brink B, De Foor W et al (2016) Botulinum toxin injection in the pediatric population with medically refractory neuropathic bladder. J Pediatr Urol 12(2):104.e1–104.e6

    Article  CAS  Google Scholar 

  63. Anquetil C, Abdelhamid S, Gelis A, Fattal C (2016) Botulinum toxin therapy for neurogenic detrusor hyperactivity versus augmentation enterocystoplasty: impact on the quality of life of patients with SCI. Spinal Cord 54(11):1031–1035

    Article  CAS  PubMed  Google Scholar 

  64. Piaggio L, Myers S, Figueroa T et al (2007) Influence of type of conduit and site of implantation on the outcome of continent catheterizable channels. J Pediatr Urol 3(3):230–234

    Article  PubMed  Google Scholar 

  65. Stein R, Rubenwolf P (2014) Metabolic consequences after urinary diversion. Front Pediatr 2:15

    Article  PubMed  PubMed Central  Google Scholar 

  66. Shekarriz B, Upadhyay J, Demirbilek S et al (2000) Surgical complications of bladder augmentation: comparison between various enterocystoplasties in 133 patients. Urology 55(1):123–128

    Article  CAS  PubMed  Google Scholar 

  67. Sylora J, Gonzalez R, Vaughn M, Reinberg Y (1997) Intermittent self-catheterization by quadriplegic patients via a catheterizable Mitrofanoff channel. J Urol 157(1):48–50

    Article  CAS  PubMed  Google Scholar 

  68. Hakenberg O, Ebermayer J, Manseck A, Wirth M (2001) Application of the Mitrofanoff principle for intermittent self-catheterization in quadriplegic patients. Urology 58(1):38–42

    Article  CAS  PubMed  Google Scholar 

  69. Vaidyanathan S, Soni B, Singh G et al (2011) Barriers to implementing intermittent catheterisation in spinal cord injury patients in Northwest Regional Spinal Injuries Centre, Southport, UK. Sci World J 11:77–85

    Article  Google Scholar 

  70. Sorokin I, De E (2015) Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization. Neurourol Urodyn 34(2):167–176

    Article  PubMed  Google Scholar 

  71. Farag F, Koens M, Sievert K et al (2016) Surgical treatment of neurogenic stress urinary incontinence: a systematic review of quality assessment and surgical outcomes. Neurourol Urodyn 35(1):21–25

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Jairam R. Eswara

  2. Nicklaus Children’s Hospital, Joe DiMaggio Children’s Hospital, University of Miami, Miami, USA

    Miguel Castellan

  3. Jugend-Krankenhaus, Hannover, Germany

    Ricardo González

  4. Universitatsmedizin Berlin Charite, Virchow Campus, Berlin, Germany

    Ricardo González

  5. Thomas Jefferson University, Philadelphia, USA

    Ricardo González

  6. Hospital Humberto J. Notti, Mendoza, Argentina

    Nicolas Mendieta

  7. Department of Pediatric Urology, Boston Children’s Hospital, Harvard Medical School, Boston, USA

    Marc Cendron

Authors
  1. Jairam R. Eswara
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  2. Miguel Castellan
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  3. Ricardo González
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  4. Nicolas Mendieta
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  5. Marc Cendron
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Contributions

JRE, MC—Manuscript writing/editing, project development. MC, RG, NM—Manuscript writing/editing.

Corresponding author

Correspondence to Jairam R. Eswara.

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The authors declare that they have no conflict of interest.

Human and animal rights statement

This manuscript does not directly involve human subjects.

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Informed consent was not required for this study.

Additional information

This work represents the efforts of the SIU–ICUD joint consultation on the Urological Management of Children with Spinal Cord Injuries. The workgroup assembled for this topic surveyed the literature regarding spinal cord injuries among the pediatric population, and the results are presented herein.

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Eswara, J.R., Castellan, M., González, R. et al. The urological management of children with spinal cord injury. World J Urol 36, 1593–1601 (2018). https://doi.org/10.1007/s00345-018-2433-1

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  • DOI: https://doi.org/10.1007/s00345-018-2433-1

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