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Dysfunction of the lower urinary and distal gastrointestinal tracts in pediatric patients with known spinal cord problems.
- Source :
-
Pediatric clinics of North America [Pediatr Clin North Am] 2001 Dec; Vol. 48 (6), pp. 1587-630. - Publication Year :
- 2001
-
Abstract
- Destruction of the urinary tract in children with elimination, storage, and holding dysfunction of the lower urinary and the distal GI tracts is caused primarily by high intravesical pressure. UTI accelerates this process. The LPP and the status of the urethral control mechanism and its relationship to the detrusor are the primary determinants of intravesical pressure. Intravesical pressures of more than 40 cm H2O are dangerous because they cause a pressure gradient that is transmitted proximally to the renal papillae, which results in the cessation of renal blood flow and a loss of renal function over time. Hydroureteronephrosis, VUR, UTI, urinary incontinence, and calculi formation also may occur. If these dangerously high intravesical pressures remain untreated, renal failure is likely to occur over time. These children then require dialysis or renal transplantation to survive, which is tragic and represents an enormous economic cost to society. Renal failure and upper urinary tract damage is nearly 100% preventable with early and appropriate evaluation and treatment. CIC is a crucial part of the management of these children and has been shown to be safe and effective, even in newborn boys. The use of the Credé maneuver (i.e., manual compression) to empty the bladder is obsolete and should be abandoned. The distal GI tract is inseparable from the lower urinary tract and must be treated simultaneously. Failure to treat the distal GI tract yields poor clinical results and much patient dissatisfaction and makes it difficult or impossible to treat the child's urinary tract problem successfully. Bowel-management programs must include daily high water and fiber intake, together with digital perianal stimulation or fecal extraction. Neuropathic bladder and bowel problems that are intractable to conservative medical and mechanical (i.e., CIC and digital perianal stimulation or fecal extraction, respectively) management almost always can be corrected surgically with high success rates in cooperative patients. Finally, neuropathic bladder and bowel problems can be extremely isolating and debilitating problems. Psychologic counseling and emotional support must be provided as needed. The care that these patients receive must be organized, comprehensive, and correlated with these patients' lifestyles. If these children are evaluated and treated early, they have the potential to live long, healthy, and productive lives.
- Subjects :
- Biophysical Phenomena
Biophysics
Child
Colon innervation
Colon physiology
Colonic Diseases physiopathology
Colonic Diseases therapy
Humans
Rectal Diseases physiopathology
Rectal Diseases therapy
Rectum innervation
Rectum physiology
Spinal Cord Diseases therapy
Urethra innervation
Urethra physiology
Urethral Diseases diagnosis
Urethral Diseases physiopathology
Urethral Diseases therapy
Urinary Bladder innervation
Urinary Bladder physiology
Urinary Bladder Diseases diagnosis
Urinary Bladder Diseases physiopathology
Urinary Bladder Diseases therapy
Colonic Diseases etiology
Rectal Diseases etiology
Spinal Cord Diseases complications
Urethral Diseases etiology
Urinary Bladder Diseases etiology
Subjects
Details
- Language :
- English
- ISSN :
- 0031-3955
- Volume :
- 48
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Pediatric clinics of North America
- Publication Type :
- Academic Journal
- Accession number :
- 11732132
- Full Text :
- https://doi.org/10.1016/s0031-3955(05)70393-x