perineal sensation ppt

8/2/2019 Perineal Sensation Ppt

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Perineal sensation :an important predictor of long-term outcome in

open spina bifida

P Oakeshott, G M Hunt, R H Whitaker, S KerryArch Dis Child 2007;92:67 70.

P Oakeshott, S Kerry, Community Health Sciences, St Georges, University of London,

London, UKG M Hunt , Department of Urology, Addenbrookes Hospital, Cambridge,UK R H Whitaker , Department of Anatomy, University of Cambridge,Cambridge, UK


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Objectives:

perineal sensation in infants with

open spina bifida is associated with a betterlong-term outcome,

particularly in terms of survival, renal-relateddeaths and incontinence.


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Methods:

prospective cohort study on a complete cohort of 117 consecutive patients Operated non-selectively at birth between 1963 and

1971 Sensation was defined at birth and subsequently

using a sterile needle starting from the most distaldermatomes

response was recorded positive only if the child criedor made a facial grimace

negative even if there was reflex movement of thelegs or an anal reflex


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Contd

Kaplan Meier curves used to compare survival andcauses of death in those with and without perinealsensation, using log rank tests.

urinary and faecal continence in survivors with and

without perineal sensation using Fishers exact test (36 cases (54%) autopsy reports were available)


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RESULTS 67 (57%) of the cohort (n=117) had died, a fifth

before their first birthday and a third by age 5 years death rate remained constant, with about 10% of the

remainder dying every 10 years 50 survivors (mean age 38 years, range 35 41) in

2005 23 survivors with perineal sensation were continent

of urine six used intermittent catheterisation, four used pads,

two had an indwelling catheter and one had aurinary diversion


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no perineal sensation, one was continent of urine ,

eight used intermittent catheterisation , six had an indwelling catheter , five had a urinary diversion , two used a penile sheath and five used only pads .

Three of the 23 male survivors have becomefathers

two with perineal sensation conceived naturally intracytoplasmic sperm injection (one)


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Figure 1- Survival related to perineal sensation in infancy in 117consecutive cases of open spina bifida.


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Figure 2- Renal deaths related to perineal sensation in infancy in 117consecutive cases of open spina bifida.


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Figure 4 Neurological deficit in terms of sensory level related to perineal sensation

and renal deaths in 117 cases of open spina bifida.

*x2 test for trend p,0.001 (asymmetrical sensory level excluded from the analysis).


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DISCUSSION first study to conclusively show that perineal sensation in

infancy predicts long-term survival, renal prognosis, andurinary and faecal continence in open spina bifida

death from renal complications, and these deathscontinued to occur throughout adulthood

Not aware of a full bladder, May not have the urge to empty it; an ordinary midstream urine specimen may be an

impossible Acute urinary retention, cystitis or bladder calculus is unlikely to be accompanied by pain or dysuria may fail to notice skin damage


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Strengths and weaknesses of the study the long duration and 100% follow-up backed by

meticulous recording of clinical findings in infancy data on urodynamics and renal function are

incomplete

results may not apply to different populations orethnic groups


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Comparison with other studies Lorber followed 270 consecutive, unselected patients with

spina bifida to the age of 9 years, 4 of whom 97 (36%) died renal deaths (n=13) occurred only in

thoracolumbar lesions, severe paraplegia, gross hydrocephalus and kyphosis


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A community-based study of 527 Nordic children

aged 4 18 years with spina bifida found that only 8%had normal urinary control and 22% normal bowelcontrol,

Stark suggested asymmetrical lesions with sparing of one leg usually implied normal bladder function

Aspine study, including 142 Dutch 16 25-year oldsfound that those with a sensory level below

L5 were more likely than those with higher lesions to

becontinent of urine and faeces


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Conclusion Simple assessment of perineal sensation in infancy

predicts long-term outcome in terms of survival, renal

prognosis and continence in open spina bifida.

Although the results may not be fully generalisable, thisclinical finding may be particularly useful in countries

with less access to sophisticated technology and where

the incidence of spina bifida remains high


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perineal sensation ppt

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