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Laetitia M O De Kort - One of the best experts on this subject based on the ideXlab platform.
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urinary considerations for adult patients with Spinal Dysraphism
Nature Reviews Urology, 2015Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Tom P V M De JongAbstract:The incidence of newborns with Spinal Dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with Spinal Dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of Spinal Dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future developments.
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cross sectional study of determinants of upper and lower urinary tract outcomes in adults with Spinal Dysraphism new recommendations for urodynamic followup guidelines
The Journal of Urology, 2014Co-Authors: Paul W Veenboer, Tom P V M De Jong, Pieter Dik, J Ruud L H Bosch, Peter F W M Rosier, Floris W A Van Asbeck, Laetitia M O De KortAbstract:Purpose: Although annual urodynamic study is currently recommended for all adults with Spinal Dysraphism, this followup might be overly intensive. Therefore, in this cross-sectional study we examine which determinants of upper and lower urinary tract outcomes are associated with relevant urodynamic findings.Materials and Methods: All patients visiting our specialized outpatient clinic for adults with Spinal Dysraphism during a 26-month period underwent evaluation of the lower urinary tract by (video)urodynamic study. High end filling pressure (40 cm H2O or greater), poor compliance (less than 10 ml/cm H2O) and high detrusor leak point pressure (40 cm H2O or greater) were classified as relevant findings and together called unsafe bladder. Multivariable analysis was performed to reveal determinants of unsafe bladder (type of Spinal Dysraphism, being wheelchair bound, hydrocephalus, urological symptoms and renal dilatation) and diagnostic accuracy was calculated for the significant determinants.Results: Of t...
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behavioral effects of long term antimuscarinic use in patients with Spinal Dysraphism a case control study
The Journal of Urology, 2013Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Jaap Huisman, Caroline F Kuijper, Pieter Dik, Tom P V M De JongAbstract:Purpose: We explored possible associations between long-term antimuscarinic use and behavioral problems in children with Spinal Dysraphism and neurogenic bladder.Materials and Methods: Children with open and closed Spinal Dysraphism were recruited from 2 pediatric hospitals, 1 in Amsterdam and 1 in Utrecht, The Netherlands. At the Amsterdam facility antimuscarinics were prescribed in selected patients with detrusor overactivity. At the Utrecht facility antimuscarinics were prescribed from birth onward in patients with Spinal Dysraphism beginning in the early 1990s. Parents of study participants were asked to fill out a Child Behavior Checklist. Demographics, data on level and type(s) of lesion, and presence of hydrocephalus with a drain (and, if applicable, number of drain revisions) were retrieved for each patient. Cases and controls (8 boys and 8 girls per group) were matched on a 1-to-1 basis.Results: Data on 32 children were analyzed. Median age was 10.6 years in cases and 10.5 years in controls (p = ...
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paucity of evidence for urinary tract outcomes in closed Spinal Dysraphism a systematic review
BJUI, 2013Co-Authors: Paul W Veenboer, J Ruud L H Bosch, Floris W A Van Asbeck, Laetitia M O De KortAbstract:Objectives To describe the long-term upper (UUT) and lower urinary tract (LUT) outcomes in patients with closed Spinal Dysraphism (CSD). CSD differs from open Spinal Dysraphism (OSD) by its long asymptomatic course and consequent later diagnosis. The outcome of UUT and LUT function in adults with CSD is relatively unknown. Patients and Methods A systematic review was performed following the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive search was made of PubMed and EMBASE. Included were papers on adults with any form of primary CSD that described bladder and/or kidney function. Only English and Dutch language papers were included. Excluded were papers on patients aged <18 years and patients with secondary tethered cord following childhood OSD repair. International Continence Society terminology was used to describe LUT outcomes. Results Eventually, only seven studies (90 patients) were included and none of these described renal outcomes. Five of the seven papers were on outcomes after untethering surgery during adulthood. Urological complaints were present in 54/79 (68.4%) patients. Urodynamic studies (48 patients available) revealed detrusor underactivity in 46.5% of the evaluated cases, detrusor overactivity in 32.6% and normal findings in 16.3% of the studied patients. Symptomatic improvement after surgery for tethered cord occurred in 33.3–90.0%, depending on the subgroup studied. Urodynamic improvement rates ranged from 11.1% to 54.5% (but based on three studies with only 24 patients). Success of surgery depended on the time between onset of symptoms and operation, and (sometimes) type of lesion. Conclusions Few data are available on long-term urological outcomes in adult patients with CSD. More extensive research on follow-up, including the functional status of the UUT, is recommended. Based upon the little evidence available, we think life-long follow-up (from birth into adulthood) of those with CSD and neurogenic bladder is advisable.
Paul W Veenboer - One of the best experts on this subject based on the ideXlab platform.
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urinary considerations for adult patients with Spinal Dysraphism
Nature Reviews Urology, 2015Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Tom P V M De JongAbstract:The incidence of newborns with Spinal Dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with Spinal Dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of Spinal Dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future developments.
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cross sectional study of determinants of upper and lower urinary tract outcomes in adults with Spinal Dysraphism new recommendations for urodynamic followup guidelines
The Journal of Urology, 2014Co-Authors: Paul W Veenboer, Tom P V M De Jong, Pieter Dik, J Ruud L H Bosch, Peter F W M Rosier, Floris W A Van Asbeck, Laetitia M O De KortAbstract:Purpose: Although annual urodynamic study is currently recommended for all adults with Spinal Dysraphism, this followup might be overly intensive. Therefore, in this cross-sectional study we examine which determinants of upper and lower urinary tract outcomes are associated with relevant urodynamic findings.Materials and Methods: All patients visiting our specialized outpatient clinic for adults with Spinal Dysraphism during a 26-month period underwent evaluation of the lower urinary tract by (video)urodynamic study. High end filling pressure (40 cm H2O or greater), poor compliance (less than 10 ml/cm H2O) and high detrusor leak point pressure (40 cm H2O or greater) were classified as relevant findings and together called unsafe bladder. Multivariable analysis was performed to reveal determinants of unsafe bladder (type of Spinal Dysraphism, being wheelchair bound, hydrocephalus, urological symptoms and renal dilatation) and diagnostic accuracy was calculated for the significant determinants.Results: Of t...
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behavioral effects of long term antimuscarinic use in patients with Spinal Dysraphism a case control study
The Journal of Urology, 2013Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Jaap Huisman, Caroline F Kuijper, Pieter Dik, Tom P V M De JongAbstract:Purpose: We explored possible associations between long-term antimuscarinic use and behavioral problems in children with Spinal Dysraphism and neurogenic bladder.Materials and Methods: Children with open and closed Spinal Dysraphism were recruited from 2 pediatric hospitals, 1 in Amsterdam and 1 in Utrecht, The Netherlands. At the Amsterdam facility antimuscarinics were prescribed in selected patients with detrusor overactivity. At the Utrecht facility antimuscarinics were prescribed from birth onward in patients with Spinal Dysraphism beginning in the early 1990s. Parents of study participants were asked to fill out a Child Behavior Checklist. Demographics, data on level and type(s) of lesion, and presence of hydrocephalus with a drain (and, if applicable, number of drain revisions) were retrieved for each patient. Cases and controls (8 boys and 8 girls per group) were matched on a 1-to-1 basis.Results: Data on 32 children were analyzed. Median age was 10.6 years in cases and 10.5 years in controls (p = ...
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paucity of evidence for urinary tract outcomes in closed Spinal Dysraphism a systematic review
BJUI, 2013Co-Authors: Paul W Veenboer, J Ruud L H Bosch, Floris W A Van Asbeck, Laetitia M O De KortAbstract:Objectives To describe the long-term upper (UUT) and lower urinary tract (LUT) outcomes in patients with closed Spinal Dysraphism (CSD). CSD differs from open Spinal Dysraphism (OSD) by its long asymptomatic course and consequent later diagnosis. The outcome of UUT and LUT function in adults with CSD is relatively unknown. Patients and Methods A systematic review was performed following the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive search was made of PubMed and EMBASE. Included were papers on adults with any form of primary CSD that described bladder and/or kidney function. Only English and Dutch language papers were included. Excluded were papers on patients aged <18 years and patients with secondary tethered cord following childhood OSD repair. International Continence Society terminology was used to describe LUT outcomes. Results Eventually, only seven studies (90 patients) were included and none of these described renal outcomes. Five of the seven papers were on outcomes after untethering surgery during adulthood. Urological complaints were present in 54/79 (68.4%) patients. Urodynamic studies (48 patients available) revealed detrusor underactivity in 46.5% of the evaluated cases, detrusor overactivity in 32.6% and normal findings in 16.3% of the studied patients. Symptomatic improvement after surgery for tethered cord occurred in 33.3–90.0%, depending on the subgroup studied. Urodynamic improvement rates ranged from 11.1% to 54.5% (but based on three studies with only 24 patients). Success of surgery depended on the time between onset of symptoms and operation, and (sometimes) type of lesion. Conclusions Few data are available on long-term urological outcomes in adult patients with CSD. More extensive research on follow-up, including the functional status of the UUT, is recommended. Based upon the little evidence available, we think life-long follow-up (from birth into adulthood) of those with CSD and neurogenic bladder is advisable.
Tom P V M De Jong - One of the best experts on this subject based on the ideXlab platform.
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urinary considerations for adult patients with Spinal Dysraphism
Nature Reviews Urology, 2015Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Tom P V M De JongAbstract:The incidence of newborns with Spinal Dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with Spinal Dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of Spinal Dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future developments.
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cross sectional study of determinants of upper and lower urinary tract outcomes in adults with Spinal Dysraphism new recommendations for urodynamic followup guidelines
The Journal of Urology, 2014Co-Authors: Paul W Veenboer, Tom P V M De Jong, Pieter Dik, J Ruud L H Bosch, Peter F W M Rosier, Floris W A Van Asbeck, Laetitia M O De KortAbstract:Purpose: Although annual urodynamic study is currently recommended for all adults with Spinal Dysraphism, this followup might be overly intensive. Therefore, in this cross-sectional study we examine which determinants of upper and lower urinary tract outcomes are associated with relevant urodynamic findings.Materials and Methods: All patients visiting our specialized outpatient clinic for adults with Spinal Dysraphism during a 26-month period underwent evaluation of the lower urinary tract by (video)urodynamic study. High end filling pressure (40 cm H2O or greater), poor compliance (less than 10 ml/cm H2O) and high detrusor leak point pressure (40 cm H2O or greater) were classified as relevant findings and together called unsafe bladder. Multivariable analysis was performed to reveal determinants of unsafe bladder (type of Spinal Dysraphism, being wheelchair bound, hydrocephalus, urological symptoms and renal dilatation) and diagnostic accuracy was calculated for the significant determinants.Results: Of t...
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behavioral effects of long term antimuscarinic use in patients with Spinal Dysraphism a case control study
The Journal of Urology, 2013Co-Authors: Paul W Veenboer, Laetitia M O De Kort, Rafal Chrzan, Jaap Huisman, Caroline F Kuijper, Pieter Dik, Tom P V M De JongAbstract:Purpose: We explored possible associations between long-term antimuscarinic use and behavioral problems in children with Spinal Dysraphism and neurogenic bladder.Materials and Methods: Children with open and closed Spinal Dysraphism were recruited from 2 pediatric hospitals, 1 in Amsterdam and 1 in Utrecht, The Netherlands. At the Amsterdam facility antimuscarinics were prescribed in selected patients with detrusor overactivity. At the Utrecht facility antimuscarinics were prescribed from birth onward in patients with Spinal Dysraphism beginning in the early 1990s. Parents of study participants were asked to fill out a Child Behavior Checklist. Demographics, data on level and type(s) of lesion, and presence of hydrocephalus with a drain (and, if applicable, number of drain revisions) were retrieved for each patient. Cases and controls (8 boys and 8 girls per group) were matched on a 1-to-1 basis.Results: Data on 32 children were analyzed. Median age was 10.6 years in cases and 10.5 years in controls (p = ...
Isabelle Bonan - One of the best experts on this subject based on the ideXlab platform.
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comparison of neurogenic lower urinary tract dysfunctions in open versus closed Spinal Dysraphism a prospective cross sectional study of 318 patients
Neurourology and Urodynamics, 2018Co-Authors: B Peyronnet, Charlene Brochard, Magali Jezequel, J Hascoet, Quentin Alimi, Nelly Senal, Beatrice Carsinnicole, Laurent Riffaud, Pierrejean Le Reste, Isabelle BonanAbstract:Aims - To compare the neurogenic lower urinary tract dysfunction (NLUTD) in patients with closed Spinal Dysraphism (CSD) versus patients with open Spinal Dysraphism (OSD) as well as their management patterns. Methods - A prospective cross-sectional study was conducted between September 2007 and December 2015 including all spina bifida patients seen at the multidisciplinary French national referral center for spina bifida. NLUTD and its management were compared between the OSD and CSD groups. Results - Three hundred and eighteen patients were included for analysis: 100 with a CSD (31.5%) and 218 with an OSD (68.6%). The prevalence of urinary incontinence did not differ significantly between the two groups (43% vs 52.8%; P = 0.11), the mean Qualiveen score was also similar (2.7 vs 2.5, P = 0.22). The voiding mechanism was clean intermittent catheterization, spontaneous voiding, suprapubic tube, and ileal conduit in 55% versus 44%; 29.8% versus 47%; 2.8% versus 3% and 11.9% versus 6% of OSD and CSD patients, respectively (P = 0.02). There were comparable prevalences of detrusor overactivity (36.5% vs 38.8%; P = 0.68) and impaired bladder compliance (34.9% vs 31.7%; P = 0.56) in both groups. Augmentation cystoplasty was more common in patients with OSD (32.1% vs 11%; P < 0.0001). Conclusions - In this prospective cohort, NLUTD were more common in OSD with a higher rate of patients requiring a surgical treatment and a lower rate of patients with preserved spontaneous voiding. However, when present, NLUTD was as severe and troublesome in patients with closed versus open Spinal Dysraphism.
B Peyronnet - One of the best experts on this subject based on the ideXlab platform.
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comparison of neurogenic lower urinary tract dysfunctions in open versus closed Spinal Dysraphism a prospective cross sectional study of 318 patients
Neurourology and Urodynamics, 2018Co-Authors: B Peyronnet, Charlene Brochard, Magali Jezequel, J Hascoet, Quentin Alimi, Nelly Senal, Beatrice Carsinnicole, Laurent Riffaud, Pierrejean Le Reste, Isabelle BonanAbstract:Aims - To compare the neurogenic lower urinary tract dysfunction (NLUTD) in patients with closed Spinal Dysraphism (CSD) versus patients with open Spinal Dysraphism (OSD) as well as their management patterns. Methods - A prospective cross-sectional study was conducted between September 2007 and December 2015 including all spina bifida patients seen at the multidisciplinary French national referral center for spina bifida. NLUTD and its management were compared between the OSD and CSD groups. Results - Three hundred and eighteen patients were included for analysis: 100 with a CSD (31.5%) and 218 with an OSD (68.6%). The prevalence of urinary incontinence did not differ significantly between the two groups (43% vs 52.8%; P = 0.11), the mean Qualiveen score was also similar (2.7 vs 2.5, P = 0.22). The voiding mechanism was clean intermittent catheterization, spontaneous voiding, suprapubic tube, and ileal conduit in 55% versus 44%; 29.8% versus 47%; 2.8% versus 3% and 11.9% versus 6% of OSD and CSD patients, respectively (P = 0.02). There were comparable prevalences of detrusor overactivity (36.5% vs 38.8%; P = 0.68) and impaired bladder compliance (34.9% vs 31.7%; P = 0.56) in both groups. Augmentation cystoplasty was more common in patients with OSD (32.1% vs 11%; P < 0.0001). Conclusions - In this prospective cohort, NLUTD were more common in OSD with a higher rate of patients requiring a surgical treatment and a lower rate of patients with preserved spontaneous voiding. However, when present, NLUTD was as severe and troublesome in patients with closed versus open Spinal Dysraphism.
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intradetrusor injections of botulinum toxin a in adults with Spinal Dysraphism
The Journal of Urology, 2018Co-Authors: B Peyronnet, J Hascoet, A Even, G Capon, Marianne De Seze, X Biardeau, M Baron, Marieaimee Perrouinverbe, Jeanmichel Boutin, C SaussineAbstract:Purpose: The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida.Materials and methods: All patients with Spinal Dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success.Results: A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (–12 cm H2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and com...
