... Id: 538117. Autor: Sager, C; Burek, C; Durán, V; López, J. C; Corbetta, J. P; Dingevan, R; We... more ... Id: 538117. Autor: Sager, C; Burek, C; Durán, V; López, J. C; Corbetta, J. P; Dingevan, R; Weller, S; Perazzo, E ... Resumo: Objetivo: Determinar si los procedimientos quirúrgicos del tracto urinario inferior, previos y complementarios al trasplante renal en pacientes que llegaron a la ...
INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder ref... more INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder refractory to anticholinergics. OBJECTIVE. To evaluate the initial effects of BoNTA in neurogenic bladders. PATIENTS AND METHODS 12 patients (9 myelomeningoceles, 1 tethered cord, 1 medullary astrocytoma, 1 Ewing's sarcoma) were studied. The pretreatment evaluation included: voiding diary, incontinence score, renovesical ultrasound, cystourethrography and urodynamic parameters. Patients received 300 UI of BoNTA via detrusor injections. They were re-evaluated at months 1, 3 and 6. After the third control, if improvement was confirmed, patients were injected again. Otherwise, surgery was indicated. Results: After the initial injection, 50% of patients achieved complete continence and 20% remained with minimal leaks. The mean maximum bladder capacity increased from 264 +/- 117 ml to 324 +/- 170 ml (P = 0.322). The mean detrusor pressure decreased from 46 +/- 17 cm H2O to 42 +/- 14 cm H2O (P=0.596). The mean bladder compliance increased from 7.6 +/- 5.9 ml/cm H2O to 10.4 +/- 6.4 ml/cm H2O (P = 0.290). The reflex voiding contractions disappeared in 2 patients; 8 presented trabeculae. Ten patients were reinjected and two underwent surgery. Conclusion: 70% urinary continence was achieved after the initial injection. No significant urodynamic changes were observed. A longer follow-up with subsequent injections is needed.
Objetivo: Restaurar función de vaciado vesical en pacientes con vejiga neurogénica por medio de l... more Objetivo: Restaurar función de vaciado vesical en pacientes con vejiga neurogénica por medio de la reinervación de la vejiga a través de la creación de reflejo sómato-visceral. Registrar complicaciones neuroquirúrgicas, urológicas y ortopédicas.Evaluar dificultades técnico-quirúrgicas y los resultados de 5 casos realizados en Argentina.Introducción: La vejiga neurogénica es una complicación secundaria al daño neurológico en los pacientes con mielomeningocele (MMC). Para lograr vaciar la vejiga deben realizar cateterismo intermitente. La técnica Xiao se basa en permitir la generación de un arco reflejo somato visceral por medio de una anastomosis entre una raíz eferente donante y la raíz motora S2 S3 que permita el vaciado vesical sin cateterismo.Material y métodos: Por medio de un estudio descriptivo retrospectivo, se analizan losresultados obtenidos luego de realizar la técnica Xiao, en el año 2010, en 5 pacientes con MMC y vejiga neurogénica. Los pacientes fueron operados en el In...
The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (M... more The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.
OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and t... more OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. METHODS A retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a non-functional moiety between August 2007 to December 2019 was conducted at three centers. 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: a) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of VUR, and DRF on renal scintigraphy; and b) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, fUTI, LUTS, and need for further surgery. Findings were considered statistically significant at p <0.05. RESULTS Postoperative complications were observed in five patients (3.8%). Six patients (4.6 %) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries (OR 4.91 - p 0.0415) and the occurrence of postoperative fUTI (OR 2.81 -p 0.0376). A 13.9% incidence of LUTS was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. CONCLUSION Laparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found.
Journal of pediatric rehabilitation medicine, Dec 11, 2017
The purpose of this paper is to render an account of the experience of a group of healthcare prov... more The purpose of this paper is to render an account of the experience of a group of healthcare providers and to propose innovative solutions for patients with Spina Bifida (SB) in Argentina. Based on our practice, patients reach specialists too late (40% already undergoing chronic kidney disease stage 1). However, several strategies were implemented in order to reverse this trend, among which were: the setting up of a professional network (via emails and Google groups), team training at different locations, videoconferences, and calling the Ministry of Health to action. Additionally, we developed a project through telemedicine to inform patients and empower caregivers throughout Argentina.
... Id: 538117. Autor: Sager, C; Burek, C; Durán, V; López, J. C; Corbetta, J. P; Dingevan, R; We... more ... Id: 538117. Autor: Sager, C; Burek, C; Durán, V; López, J. C; Corbetta, J. P; Dingevan, R; Weller, S; Perazzo, E ... Resumo: Objetivo: Determinar si los procedimientos quirúrgicos del tracto urinario inferior, previos y complementarios al trasplante renal en pacientes que llegaron a la ...
INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder ref... more INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder refractory to anticholinergics. OBJECTIVE. To evaluate the initial effects of BoNTA in neurogenic bladders. PATIENTS AND METHODS 12 patients (9 myelomeningoceles, 1 tethered cord, 1 medullary astrocytoma, 1 Ewing's sarcoma) were studied. The pretreatment evaluation included: voiding diary, incontinence score, renovesical ultrasound, cystourethrography and urodynamic parameters. Patients received 300 UI of BoNTA via detrusor injections. They were re-evaluated at months 1, 3 and 6. After the third control, if improvement was confirmed, patients were injected again. Otherwise, surgery was indicated. Results: After the initial injection, 50% of patients achieved complete continence and 20% remained with minimal leaks. The mean maximum bladder capacity increased from 264 +/- 117 ml to 324 +/- 170 ml (P = 0.322). The mean detrusor pressure decreased from 46 +/- 17 cm H2O to 42 +/- 14 cm H2O (P=0.596). The mean bladder compliance increased from 7.6 +/- 5.9 ml/cm H2O to 10.4 +/- 6.4 ml/cm H2O (P = 0.290). The reflex voiding contractions disappeared in 2 patients; 8 presented trabeculae. Ten patients were reinjected and two underwent surgery. Conclusion: 70% urinary continence was achieved after the initial injection. No significant urodynamic changes were observed. A longer follow-up with subsequent injections is needed.
Objetivo: Restaurar función de vaciado vesical en pacientes con vejiga neurogénica por medio de l... more Objetivo: Restaurar función de vaciado vesical en pacientes con vejiga neurogénica por medio de la reinervación de la vejiga a través de la creación de reflejo sómato-visceral. Registrar complicaciones neuroquirúrgicas, urológicas y ortopédicas.Evaluar dificultades técnico-quirúrgicas y los resultados de 5 casos realizados en Argentina.Introducción: La vejiga neurogénica es una complicación secundaria al daño neurológico en los pacientes con mielomeningocele (MMC). Para lograr vaciar la vejiga deben realizar cateterismo intermitente. La técnica Xiao se basa en permitir la generación de un arco reflejo somato visceral por medio de una anastomosis entre una raíz eferente donante y la raíz motora S2 S3 que permita el vaciado vesical sin cateterismo.Material y métodos: Por medio de un estudio descriptivo retrospectivo, se analizan losresultados obtenidos luego de realizar la técnica Xiao, en el año 2010, en 5 pacientes con MMC y vejiga neurogénica. Los pacientes fueron operados en el In...
The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (M... more The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.
OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and t... more OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. METHODS A retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a non-functional moiety between August 2007 to December 2019 was conducted at three centers. 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: a) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of VUR, and DRF on renal scintigraphy; and b) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, fUTI, LUTS, and need for further surgery. Findings were considered statistically significant at p <0.05. RESULTS Postoperative complications were observed in five patients (3.8%). Six patients (4.6 %) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries (OR 4.91 - p 0.0415) and the occurrence of postoperative fUTI (OR 2.81 -p 0.0376). A 13.9% incidence of LUTS was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. CONCLUSION Laparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found.
Journal of pediatric rehabilitation medicine, Dec 11, 2017
The purpose of this paper is to render an account of the experience of a group of healthcare prov... more The purpose of this paper is to render an account of the experience of a group of healthcare providers and to propose innovative solutions for patients with Spina Bifida (SB) in Argentina. Based on our practice, patients reach specialists too late (40% already undergoing chronic kidney disease stage 1). However, several strategies were implemented in order to reverse this trend, among which were: the setting up of a professional network (via emails and Google groups), team training at different locations, videoconferences, and calling the Ministry of Health to action. Additionally, we developed a project through telemedicine to inform patients and empower caregivers throughout Argentina.
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Papers by Cristian Sager