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1.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31980545

RESUMO

BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. METHODS: Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS: The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS: There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.


Assuntos
Meningomielocele/cirurgia , Adaptação Psicológica , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Encefalocele/epidemiologia , Família , Feminino , Seguimentos , Humanos , Hidrocefalia/cirurgia , Masculino , Cuidado Pós-Natal , Gravidez , Cuidado Pré-Natal , Qualidade de Vida , Rombencéfalo , Resultado do Tratamento
2.
World Neurosurg ; 133: e397-e400, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526889

RESUMO

OBJECTIVE: Neonatal hydrocephalus remains a difficult condition to manage, due to high failure rates among all management strategies. Neurosurgeons commonly manage hydrocephalus with ventriculoperitoneal shunt (VPS) implantation, and valves of variable sizes and profiles are available for implantation. This study examines primary ventricular shunt valve implantation complication rates based on valve profiles in pediatric patients with hydrocephalus. METHODS: This study retrospectively reviews pediatric patients younger than 1 year of age who underwent ventricular shunt placement at a single institution from January 2001 to January 2017. Patients were classified by valve profile and categorized as either ultrasmall valves or regular-sized valves. Time until complication and type of complication were studied. RESULTS: A total of 156 patients met the inclusion criteria. Forty-eight (31%) patients received an ultrasmall shunt valve, while 108 patients received a regular valve. On average, patients undergoing ultrasmall valve placement were younger (2.1 months) than patients undergoing placement of regular valves (3.1 months) (P = 0.03). The overall complication rate within 2 years of VPS placement was 37.5% in patients with the ultrasmall valve and 41.7% in the regular valve population. There was no difference in 1-year shunt survival rate between the 2 cohorts. CONCLUSION: Our review did not find a significant difference in complication rates between ultrasmall and regular valves in patients under 1 year of age. However, the etiology of shunt malfunction did differ between the groups. This work further supports evidence suggesting a surgeon's preference for shunt hardware alone does not significantly impact outcome.


Assuntos
Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Tamanho Corporal , Peso Corporal , Desenho de Equipamento , Falha de Equipamento , Feminino , Idade Gestacional , Humanos , Hidrocefalia/congênito , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Masculino , Meningomielocele/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Derivação Ventriculoperitoneal/efeitos adversos
3.
J Urol ; 203(1): 199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31644375
5.
Pediatr Clin North Am ; 67(1): 45-57, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31779836

RESUMO

Neuromuscular disorders are pathologies that can severely affect the quality of life as well as longevity of patients. The most common disorders include cerebral palsy and myelodysplasia. The orthopedic manifestations of these disorders can be treated operatively or nonoperatively. Both focus on the prolongation of mobility and preservation of ambulatory capacity for patients.


Assuntos
Doenças Musculoesqueléticas/etiologia , Doenças Neuromusculares/complicações , Paralisia Cerebral/complicações , Criança , Humanos , Meningomielocele/complicações , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Disrafismo Espinal/complicações
6.
J Urol ; 203(1): 194-199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31479395

RESUMO

PURPOSE: In utero myelomeningocele closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared bladder status in patients who underwent fetal myelomeningocele surgery versus postnatal repair. MATERIALS AND METHODS: We retrospectively reviewed our database, with group 1 consisting of in utero surgery and group 2 consisting of postnatal repair. Group 3 was a subgroup of group 2, including patients initially presenting at age less than 12 months. We recorded medical history, radiological investigation with renal ultrasonography, voiding cystourethrography, urodynamic evaluation and clinical outcome of the bladder pattern after treatment. RESULTS: We identified 88 patients in group 1, 86 in group 2 and 38 in group 3. The incidence of urinary tract infection was higher in the postnatal period (45% vs 20%). Hydronephrosis occurred in 20.7%, 22.6% and 28.9% of patients in groups 1, 2 and 3, respectively. Vesicoureteral reflux was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in group 1 and no difference in other urodynamic parameters. The high risk bladder pattern at initial evaluation occurred in 56%, 50% and 46% of patients in groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after treatment in all groups. CONCLUSIONS: In utero repair did not improve urological parameters compared to repair in the postnatal period.


Assuntos
Feto/cirurgia , Meningomielocele/cirurgia , Complicações Pós-Operatórias/epidemiologia , Feminino , Humanos , Hidronefrose/epidemiologia , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Infecções Urinárias/epidemiologia , Refluxo Vesicoureteral/epidemiologia
9.
BMC Surg ; 19(1): 164, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694612

RESUMO

BACKGROUND: Triple neural tube defects are rare. To the author's knowledge, there are only four reported cases available in the literature up to date. Controversies exist with regards to the development of neural tube defects. We revisit the multisite closure theory and try to explain the mechanism of neural tube defects in our case. CASE PRESENTATION: We report a case of one-month-old baby boy who presented to us with three distinct neural tube defects. He had occipital and cervical encephaloceles along with thoracolumbar myelomeningocele accompanied by syrinx and mild hydrocephalus. All the three defects were surgically corrected with good neurological outcome. CONCLUSION: In the multisite model of human neural tube closure, there are only two fusion sites and two neuropores unlike in mouse. This can explain the origin of open neural tube defects including anencephaly and myelomeningocele (as in our case) but cannot account for the development of encephalocele, which appears to be a post neurulation defect.


Assuntos
Encefalocele/cirurgia , Meningomielocele/cirurgia , Defeitos do Tubo Neural/cirurgia , Humanos , Lactente , Masculino , Pescoço
10.
J Craniofac Surg ; 30(8): 2517-2519, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567772

RESUMO

The aim was to analyze systemic and oral aspects of patients with myelomeningocele (MMC), relevant for their dental treatment. Dental treatment of these individuals requires the dentist's extensive knowledge and careful information to determine the dental treatment plan. Thirty participants aged 3 to 16 years were divided into 2 groups: study group (15 MMC individuals) and control group (15 healthy subjects). All patients were evaluated for: systemic conditions, use of medications, sequela of the underlying pathology, oral hygiene, diseases, convulsion, cerebrospinal fluid (CSF), allergy, behavior, learning, and mouth physical examination to assess the oral conditions. The study group presented: higher percentage using drugs (P < 0.05), 40% had convulsions (P < 0.05), 86.67% using CSF shunt, 53.33% presented latex allergies (P < 0.05), 53.33% were classified as anxious and with cognitive deficit (P < 0.05), showed more gingivitis (P < 0.05). The MMC individuals, in the majority, have shown cognitive impairment and anxious behavior, use of controlled drugs, convulsion, CSF shunt use, and latex allergy. The presence of periodontal tissue damage was higher in patients with MMC.


Assuntos
Meningomielocele/cirurgia , Adolescente , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Gengivite , Humanos , Meningomielocele/etiologia , Higiene Bucal , Convulsões/complicações
11.
Top Spinal Cord Inj Rehabil ; 25(3): 241-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548791

RESUMO

Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance (p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.


Assuntos
Bacteriúria/etiologia , Cateterismo Uretral Intermitente/efeitos adversos , Meningomielocele/complicações , Bexiga Urinaria Neurogênica/etiologia , Urodinâmica , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
13.
J Perinat Med ; 47(7): 771-774, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31487264

RESUMO

Background Spina bifida affects 0.5-1 in 1000 pregnancies in the United States and is often diagnosed in the mid-second trimester. The objective of the study was to directly compare ultrasounds (US) and magnetic resonance imaging (MRI) obtained in the antenatal period in the diagnosis and localization of fetal myelomeningocele (MMC) and compare these with the postnatal outcomes of these infants Methods A retrospective analysis of patients referred to the Fetal Care Center at the Cleveland Clinic from 2005 to 2017. US and MRIs were obtained from the Cleveland Clinic electronic medical record. Infants were followed-up at an interdisciplinary myelomeningocele pediatrics clinic. Results MRI and US varied in correlation with physical exam at the time of birth and surgery. While no differences were detected in demographics, pregnancy outcomes or pediatric outcomes, it was noted that the majority of patients developed neurogenic bladders irrespective of the lesion level. Conclusion MRI is not superior to US in the diagnosis of MMC. Pregnancies complicated by MMC do not vary in morbidity, and pediatric outcomes remain similar regardless of the lesion level. This data provides additional information for the counseling of patients when faced with this antenatal diagnosis.


Assuntos
Imagem por Ressonância Magnética/métodos , Meningomielocele , Procedimentos Neurocirúrgicos/efeitos adversos , Coluna Vertebral/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Bexiga Urinaria Neurogênica , Adulto , Feminino , Humanos , Recém-Nascido , Meningomielocele/complicações , Meningomielocele/diagnóstico , Meningomielocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/normas , Reprodutibilidade dos Testes , Coluna Vertebral/anormalidades , Estados Unidos , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/etiologia
14.
Braz J Med Biol Res ; 52(8): e8671, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389492

RESUMO

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.


Assuntos
Volume Expiratório Forçado/fisiologia , Meningomielocele/fisiopatologia , Músculos Respiratórios/fisiopatologia , Capacidade Vital/fisiologia , Cadeiras de Rodas , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Dados Preliminares , Testes de Função Respiratória
15.
Med Arch ; 73(2): 126-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391703

RESUMO

Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board's ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn-birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.


Assuntos
Anormalidades Múltiplas , Aborto Eugênico , Doenças Fetais , Hidrocefalia , Meningomielocele , Espinha Bífida Cística , Aborto Eugênico/ética , Aborto Eugênico/legislação & jurisprudência , Bósnia e Herzegóvina , Cesárea , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Cuidados Paliativos , Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal , Adulto Jovem
16.
J Craniofac Surg ; 30(8): 2628-2631, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369512

RESUMO

PURPOSE: Latissimus dorsi (LD) flaps are frequently used in the prenatal meningomyelocele (MMC) repairs; on that basis, this study aims to reveal the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN) in fetal cadavers with MMC defects, with an anatomical perspective. METHODS: The study was conducted on 7 formalin-fixed human fetal cadavers (4 males and 3 females) with MMC defects, aged from 18 to 27 weeks of gestation. The size of LD, TDA, and TDN including their area, length, and width were measured by a digital caliper and digital image analysis software. Our direct measurements were compared with the corresponding estimations of a previous study in the literature which provides regression formulae based on gestational age. RESULTS: The fetal cadavers with MMC had bilateral LD. No significant differences were found in the numerical data of anatomical structures between the sides or the sexes. LD size (ie, area, length and width) was approximately 3% to 10% smaller in the fetuses with MMC defects than that of the normal fetuses. Unilateral LD flap in a 22-week-old fetus with a large MMC was evaluated as insufficient to close the defects. CONCLUSION: Ten percent shrinkage in the area of LD might be too critical to be disregarded by surgeons during the closure of MMC defects. The dimensional findings about LD (area, length, and width) may be helpful in planning of LD flap harvesting for the repairs of MMC.


Assuntos
Meningomielocele/cirurgia , Músculos Superficiais do Dorso/transplante , Artérias , Cadáver , Feminino , Feto , Idade Gestacional , Humanos , Masculino , Retalhos Cirúrgicos/irrigação sanguínea
17.
Wiad Lek ; 72(7): 1380-1386, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31398173

RESUMO

Spina bifida (myelomeningocele) is the most prevalent developmental defect of the nervous system. In different regions of the world it affects from 0.3 to 5 per 1000 of living neonates. It is known that the defect develops during the early fetal life however no explicit cause has been found yet. Recently it has been accepted that one of the major factors contributing to spina bifida is deficiency of folic acid in the mother's body before and during pregnancy. The first attempts to cure myelomeningocele were taken in ancient times. More extensive knowledge of aetiology and effects of spina bifida and development of new surgical techniques allowed for management not only of the defect itself but also the consequent complications. Prenatal spina bifida repair has been performed in the USA for 20 years now while European surgeons (Poland and Switzerland) have operated myelomeningocele for 12 years. Comparative analysis carried out to evaluate the patients operated for spina bifida prenatally and postnatally pointed that those after fetal repair demand the use of ventriculoperitoneal shunt for hydrocephalus twice less frequently. Thanks to shortened exposure of the spinal cord and the spinal nerves to the toxic effect of amniotic fluid and reduced exposure to mechanical injuries, prenatal myelomeningocele repair offers better opportunities to improve motor, urinary and alimentary functions, contributing then statistically to higher quality of lives of children with spina bifida.


Assuntos
Hidrocefalia , Meningomielocele , Disrafismo Espinal , Feminino , Humanos , Recém-Nascido , Polônia , Gravidez , Qualidade de Vida
18.
J Neurosci Nurs ; 51(5): 217-220, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31469703

RESUMO

BACKGROUND: Myelomeningoceles are routinely closed surgically within 24 to 48 hours after birth; the defect and exposed placode must be protected from further damage from excoriation and contamination until surgery. PURPOSE: Two methods to keep the defect moist and clean are used at our large Midwestern children's hospital: the occlusive and the drip. There was no agreement between the neonatal and neurosurgical teams as to which technique was superior, hence the need for a formal evaluation. METHODS: A prospective, randomized trial was conducted to compare the ease of nursing care, cost of supplies, neonatal temperature, and moisture of the placode at the time of closure in neonates with a myelomeningocele. RESULTS: Nurses categorized the occlusive group as easy care (100%) compared with 60% for the drip group, although the difference was not statistically significant (P = .18). The mean temperatures of the 2 groups before surgery were identical (36.9°C) in both groups. The cost of the drip was 6 times higher than that of the occlusive technique. The placode was assessed as moist in all 13 cases (100%). CONCLUSION: The occlusive technique was easier to care for by all the nurses and was 6 times more cost effective. Both methods kept the placode moist and did not affect the temperature of the baby.


Assuntos
Meningomielocele/cirurgia , Enfermagem Neonatal/normas , Curativos Oclusivos/economia , Curativos Oclusivos/normas , Feminino , Hospitais Pediátricos , Humanos , Recém-Nascido , Masculino , Meio-Oeste dos Estados Unidos , Estudos Prospectivos
19.
Ir Med J ; 112(5): 930, 2019 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-31411012

RESUMO

Aim The aim of this study is to outline the role of primary external ventricular drains (EVD) in the management of open myelomeningoceles in the neonatal setting in Ireland. Methods Retrospective cohort study involving all infants who underwent open myelomeningocele repair in a teritary centre in Ireland between January 2009 and April 2016. Medical charts and laboratory data was reviewed on all infants meeting the inclusion criteria. Results One hundred and forty-three neonates underwent open myelomeningocele repair in the 6.5 year period. EVD were inserted at the time of primary wound closure in 19 cases (13%). EVD were used to aid in wound closure and as a primary method of cerebrospinal fluid (CSF) diversion. They remained in place for a median of 8 days, ranging from 1-22 days. All EVD, apart from one, in our series were replaced by a ventricular-peritoneal (VP) shunt at some stage. Conclusion EVD were used in 13% of cases of open myelomeningocele repairs from Jan 2009-Apr 2016 as a primary measure to aid in management. Compared to the cohort in whom an EVD was not inserted at the time of surgery, there was a decrease in the rate of infections. However, there was an increased rate of wound dehiscence/leak and a later need for VP shunt insertion.


Assuntos
Meningomielocele/cirurgia , Ventriculostomia , Drenagem/métodos , Drenagem/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Irlanda , Masculino , Estudos Retrospectivos , Derivação Ventriculoperitoneal/métodos , Derivação Ventriculoperitoneal/estatística & dados numéricos , Ventriculostomia/métodos , Ventriculostomia/estatística & dados numéricos
20.
Urology ; 132: 210-211, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299327

RESUMO

OBJECTIVE: Electromotive drug administration (EMDA) presents a minimally invasive method of intravesical instillation of therapeutic agents without the need for general anesthesia.1 It employs a combination of iontophoresis, electrophoresis, and electroporation to deliver drugs into deep tissue layers using an electrical current created between 2 electrodes.2 This video shows feasibility of botulinum toxin type A (BoNTA) EMDA in myelomeningocele children with urinary incontinence secondary to neuropathic detrusor overactivity. METHODS: In this technique (Video 1), catheterization was performed with a 10-Fr (CE-DAS, UROGENICS/Ag 9900 (pediatric), Mirandola, Italy) catheter electrode, after providing a local transurethral anesthesia with 2% lidocaine gel. The cuff of the catheter was filled by 2 cc saline solution. The bladder was then drained and irrigated with 0.9% saline solution until the catheter outflow became clear. The bladder was subsequently filled with sterile water to its maximal capacity. BoNTA (Dysport) at a dose of 10 IU/kg was added to the intravesical solution. Negative electrode as 2 dispersive electrodes was placed on the abdomen. Positive electrode was connected to the intravesical catheter. A pulsed current generator (Physionizer 30, Physion srl, Mirandola, Italy), delivered a current with frequency of 2,800 Hz, interval of 50 µs and amplitude of 10-20 mA for 20 minutes. At the end of the procedure, the bladder was emptied. RESULTS: For the first time, BoNTA/EMDA was performed on myelomeningocele patients with urinary incontinence in our center.3 According to our prior reports, urinary incontinence improved in 75% of the patients between 2 consecutive clean intermittent catheterizations at 1-year follow-up.4 Mean maximal cystometric capacity significantly increased from 148 ± 62 mL at baseline to 239 ± 73 mL 1 year after the treatment.4 CONCLUSION: This technique is a feasible, safe, reproducible, cost effective, long lasting, and pain free method, on an outpatient basis with long-term duration of effects and without anesthesia or cystoscopy procedure.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Incontinência Urinária/tratamento farmacológico , Administração Intravesical , Tratamento Farmacológico/métodos , Eletroforese , Eletroporação , Humanos , Iontoforese , Meningomielocele/complicações , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária/etiologia
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