小兒脊柱裂併排尿障礙之案例報告

陳生文、程威銘、張彰琦、陳修聖

台北市立聯合醫院忠孝院區外科部泌尿科

Pediatric spina bifida combined with neurogenic bladder: A case report

Sheng-Wen Chen, Wei-Ming Cheng, Chang-Chi Chang, Shiou-Sheng Chen

Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao branch

Introduction:

    Spina bifida is a disease of congenital neural tube defect with malformation of spine, including spina bifida occulta, meningocele and myelomeningocele. Spina bifida occurred in lumbosacral region accounts for over 75% patients which cause neurogenic bladder and bowel. Care of child with spina bifida can be complex, requiring multidisciplinary team for medical intervention. Here we present a case of 9 year old boy, growth in low-socioeconomic family, with congenital spina bifida who suffered from neurogenic bladder and bowel incontinence.

Case presentation: 

    This 9 year old boy is a case of meningocele, received surgical intervention after birth. He had attention deficit hyperactivity disorder with autism. He also had motor and speech delay development. He suffered from recurrent high fever, bladder and bowel incontinence for many years. Kidney ultrasound revealed bilateral severe hydronephrosis with much residual urine after voiding. After his infection episode, we arrange video urodynamic study for him. Bladder trabeculation with bladder diverticula was impressed under fluoroscopy. Dilatation of bilateral ventricle and the third ventricle with tethered cord syndrome was diagnosed from further magnetic resonance imaging examination. Clean intermittent catheterization and anti-muscarinic agents was prescribed for lower intravesical pressures. Due to his poor family support, we also seek for assistance from social worker and child welfare league.

Conclusion:

    Spina bifida is a congenital neural tube defect that affects the spine and spinal cord, as well as the brain in children. Patterns of lower urinary tract dysfunction varied according to the level of defects. Early treatment and comprehensive care improve long-term health and maintain quality of life.