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Master thesis

Transition de l'adolescence à l'âge adulte des patients ayant une vessie neurologique ou malformative

Abstract : Management of people with neurogenic or malformative bladder is a lifelong medicaland surgical challenge. The transition between adolescence and adulthood is a particular period because of problems related to both patient and medical staff. The objective is to present the uro-nephrological status of these patients during the transition according to 3 criteria: continence, complications and renal function.All patients of 15 years old and over, with neurogenic or malformative bladder wereincluded. Congenital anomalies of the urethra were excluded. The transition was defined between 15 and 25 years old. Continence, surgical procedures, complications and renal function were reviewed retrospectively for each patient. Continence was defined according to a Lickert scale. Two groups were identified : operated and non-operated patients. The transition was divided into three categories: simple transition (no complication, incontinence in non-operated patients), transition with stabilized complications (urolithiasis, intestinal obstruction, bladder perforation, metabolic disorders, moderate chronic renal failure (CRF)) and complex transition (death, incontinence after surgery, severe CRF or end-stage renal failure). Some 204 patients were included of which 87 % had a neurogenic bladder. Most of them had Spina Bifida (67%). Among the 81 non-operated patients, 32 (40%) were continentand 12 (15%) had complication which 6 calculi. Moderate CRF was recorded in 2 cases and 1 patient was transplanted. 123 patients (60%) were operated, 11 had a cutaneous transintestinal ureterostomy and 112, a bladder reconstruction combining enterocystoplasty (82% of cases), bladder neck surgery (71% of cases) and/or a continent diversion (54% of cases). Continence was achieved in 80 % of cases. Stabilized complications concerned 46 patients (37 %): problems with continent channel (42 %), calculi (28%), bladder perforations (12%), and intestinal obstructions (7%). Complex complications involved 24 patients (20%), including 8 severe or end-stage renal failure. Surgery of neurogenic or malformative bladders improves urinary continence. However, it generates a high rate of complications. Regular long-term multidisciplinary follow-up is essential to reduce the morbidity of care
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https://hal.univ-lorraine.fr/hal-01733116
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  • HAL Id : hal-01733116, version 1

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Vladimir Gomola. Transition de l'adolescence à l'âge adulte des patients ayant une vessie neurologique ou malformative. Sciences du Vivant [q-bio]. 2013. ⟨hal-01733116⟩

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