Treatment alternatives for different types of neurogenic bladder dysfunction in children
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Bulking agents such as collagen, Teflon, and, more recently, dextranomer/hyaluronic acid copolymer can be injected submucosally at the bladder neck to facilitate mucosal coaptation and achieve continence.122–136 Continence rates are difficult to interpret since variable criteria have been reported to define success. In addition, some authors have failed to show a durable response with long-term follow-up.128,129,135 When defined as a dry interval of 4 hours, continence rates are in the range of 5%–63%. Success is often dependent on more than one injection, and as a result cost may become an important issue. Predictors of response to the injection of bulking agents are inconsistent but at least one group has noted improved outcomes in patients with detrusor areflexia and low-pressure bladders.129 Attempts at defining urodynamic characteristics that may serve as predictors of long-term success have been unsuccessful.137 Importantly, the injection of collagen or detranomer/hyaluronic-based implants have not been found to interfere with bladder neck surgery if the surgery is subsequently required.138
Paraurethral Injections and Other Options
Victor Gomel, Bruno van Herendael in Female Genital Prolapse and Urinary Incontinence, 2007
Deflux® is a co-polymer of dextranomer (cross-linked dextran) and nonanimal stabilized hyaluronic acid, with a superior biocompatibility. Dextran has been used for plasma-expanders and wound dressings. Rare cases of anaphylaxis have been reported with dextran, not with dextranomer. Hyaluronic acid is a universal component of the extra cellular space in all tissues and all species and is used in eye surgery, esthetic treatments and joint injections. It will be replaced by connective tissue. Deflux® does not migrate (particles 80–250 μm), is nonimmunogenic, nontoxic, noncarcinogenic, and nonteratogenic and shows no granuloma formation (17). It cannot be infected by prions, viruses or proteins. It is the only Food and Drug Administration–approved agent for endoscopic treatment of vesicoureteric reflux in children. It remains stable more than 3 years in the urinary system. Fibroblast activity and collagen ingrowth is stimulated by hyaluronic acid. Because of its low viscosity, it is easy to inject. There is a 20% volume-reduction after 1 year. It is probably somewhat less stable than Macroplastique® on the long term.
Management of antenatal hydronephrosis
Prem Puri in Newborn Surgery, 2017
Neonates with VUR are more likely to show spontaneous resolution than are older children. Indeed, 20%–35% of ureters with grade IV or V VUR have reflux resolution within 2 years; however, a significant proportion develop a breakthrough UTI, and antireflux surgery is recommended in these cases. The success rate for open surgical correction of VUR in infants can be as high as in older children.56 Another option is subureteral injection of dextranomer microspheres/hyaluronic acid into the ureterovesical junction, in which the success rate is 69% with a single injection.74
A novel probiotic therapeutic in a murine model of Clostridioides difficile colitis
Published in Gut Microbes, 2020
Rita D. Shelby, Grace E. Janzow, Lauren Mashburn-Warren, Jeffrey Galley, Natalie Tengberg, Jason Navarro, Miriam Conces, Michael T. Bailey, Steven D. Goodman, Gail E. Besner
Human-feces derived L. reuteri 23272 (American Type Culture Collection; ATCC, Manassas, VA) was grown overnight in de Man, Rogosa, and Sharpe (MRS) broth (Fisher Scientific, Pittsburgh, PA) at 37°C in 5% CO2. For planktonic L. reuteri, 1 × 109 CFU/mL was pelleted and resuspended in sterile 0.9% saline prior to gastric gavage. For L. reuteri administered with unloaded microspheres, sterile dry dextranomer microspheres (Sephadex G-25 Superfine, GE Healthcare Bio-Sciences, Pittsburgh, PA) were hydrated in a sterile saline solution overnight. For L. reuteri administered with maltose-loaded microspheres, the microspheres were hydrated in a 1 M maltose solution in normal saline overnight. All microspheres were removed from the overnight solution via vacuum filter and aseptically transferred into a tube containing the resuspended bacteria. The bacteria were allowed to incubate with the microspheres for 1 hour at room temperature to facilitate binding. Each mouse received 200 μL of the bacterial solution by gastric gavage, for a final dose of 1 × 108 CFU of Lr.
Macroplastique and Botox are superior to Macroplastique alone in the management of neurogenic vesicoureteric reflux in spinal cord injury population with presumed healthy bladders
Published in The Journal of Spinal Cord Medicine, 2019
Vasileios I. Sakalis, Rachel Oliver, Peter J. Guy, Melissa C. Davies
Nowdays, VUR is managed almost exclusively by sclerosing agents, administered as a single subureteric injection, thus minimizing the need for ureteric re-implantation which is still the golden standard and it is reserved for complicated cases.4,5 Matovschek in 1981, was the first to describe the endoscopic injection of Teflon for VUR correction.6 Since then, several bulking agents have been developed such as Polydimethylsiloxane, Polytetrafluoroethylene, Dextranomer hyaluronic acid and Glutaraldehyde Cross-linked bovine collagen etc.7 Numerous investigators have reported encouraging results but mainly in primary VUR.8 There is evidence from literature that Macroplastique (Polydimethylsiloxane: Uroplasty Inc, Geleen, the Netherlands) is effective in the management of secondary VUR due neurogenic bladder.9
A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults
Published in Acta Chirurgica Belgica, 2019
Nikhil Lal, Constantinos Simillis, Alistair Slesser, Christos Kontovounisios, Shahnawaz Rasheed, Paris P. Tekkis, Emile Tan
Maeda et al. observed no significant difference in improvement in FI symptoms with either BulkamidTM or PermacolTM [38]. Morris et al. noted no significant improvement in the mean Wexner scores with PTQTM and Durasphere® compared to baseline at 6-month follow-up [39]. Meanwhile, Tjandra et al. noted significant improvement in the mean Wexner score, MRP and FIQL in PTQTM group compared to Durasphere® at 12-month follow-up [41]. A study noted that at 6 months, dextranomer in stabilized hyaluronic acid (NASHA/Dx) did not significantly improve incontinence symptoms compared to sham treatment [37]. Dehli et al. observed no significant improvement in the Vaizey score in patients receiving NASHA/Dx injections compared to BF [36] (Supplementary Table 13).
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