Lynn Wu

106 statements · 2 topics

Featured statements

▶ Ep 2 · 8:10
for a normal person, when you go to void, your sphincter knows to relax and open so that. There's no resistance to that at all. But when you get into a situation where things are discoordinated, and one part of the bladder doesn't know what the other part of the bladder's doing, you can imagine that voiding, or trying to contract your bladder while the sphincter is still tight and closed, um, can lead to another high pressure situation
quote · Neurogenic Bladder
▶ Ep 2 · 25:50
we don't know over what time period you're gonna lose kidney function. So, there's not a Hard and fast rule to say, oh, if your pressures remain above 40, this is going to lead to loss of X amount of GFR in, in what period of time. We don't know
quote · Neurogenic Bladder
▶ Ep 3 · 6:00
a normal bladder should be a low pressure kind of situation as it fills, the compliance should be good, meaning that the change in the pressure as the volume changes should be very, very little, and that's the hallmark of a normal bladder
quote · Spina Bifida
▶ Ep 3 · 12:20
there's some data now coming out that suggests if you do it early, you may actually be able to influence how that bladder develops, and you may actually improve the overall bladder dynamics as that child grows
quote · Spina Bifida

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Lynn's statements about Neurogenic Bladder 53 statements

Open the Neurogenic Bladder collection →

Neurogenic Bladder

▶ Ep 2 · 1:06
clinical Neurogenic bladder affects children with spinal cord abnormalities including spina bifida, spinal cord injury after trauma, cloacal exstrophy, anorectal malformations, and VACTERL complex with known spinal cord problems. ↗
▶ Ep 2 · 1:06
quote Neurogenic bladder can affect a lot of different, um, um, disease states, and so we always think of spina bifida as probably the most common cause in our PES populations, but, um, truth be told, you can see neurogenic bladder, you know, in children with any spinal cord abnorm. Abnormality, a spinal cord injury, certainly after trauma ↗
▶ Ep 2 · 2:34
clinical Baseline evaluation for newborns with myelomeningocele includes renal bladder ultrasound and VCUG to assess for two kidneys, hydronephrosis, bladder shape, trabeculations, reflux, and bladder neck/urethral contour. ↗
▶ Ep 2 · 4:49
clinical The majority of children with spina bifida will have very normal imaging studies at birth, making baseline pictures important for tracking changes. ↗
▶ Ep 2 · 5:12
clinical Urodynamics should be performed within the first month or couple of months of life to measure bladder pressure and compliance during filling. ↗
▶ Ep 2 · 6:00
clinical A normal bladder should be low pressure during filling with good compliance (minimal pressure change as volume increases); pathologic or neuropathic bladders tend to have higher pressures, which is the most dangerous thing to the kidneys. ↗
▶ Ep 2 · 6:00
quote a normal bladder should be a low pressure kind of situation as it fills, the compliance should be good, meaning that the change in the pressure as the volume changes should be very, very little, and that's the hallmark of a normal bladder ↗
▶ Ep 2 · 6:50
quote hostile is a term we'll use too to indicate that the bladder has a high pressure, that the bladder is demonstrating signs of instability or it's contracting, um, during the filling, which is abnormal ↗
▶ Ep 2 · 6:50
clinical A hostile bladder is defined as having high pressure, demonstrating signs of instability, or contracting during filling (when it should be quiet and relaxed). ↗
▶ Ep 2 · 7:30
clinical Detrusor-sphincter dyssynergia (DSD) is a discoordination between the bladder and sphincter seen in neurogenic bladder, where the sphincter fails to relax during bladder contraction, creating a high-pressure situation that can damage kidneys over time. ↗
▶ Ep 2 · 8:10
quote for a normal person, when you go to void, your sphincter knows to relax and open so that. There's no resistance to that at all. But when you get into a situation where things are discoordinated, and one part of the bladder doesn't know what the other part of the bladder's doing, you can imagine that voiding, or trying to contract your bladder while the sphincter is still tight and closed, um, can lead to another high pressure situation ↗
▶ Ep 2 · 9:00
clinical DSD can occur in any neurogenic bladder situation including spinal cord injury or trauma, not just spina bifida. ↗
▶ Ep 2 · 9:37
clinical Clean intermittent catheterization (CIC) is the mainstay of management for neurogenic bladder patients, enabling complete bladder emptying, reducing pressure, and bypassing sphincter dysfunction. ↗
▶ Ep 2 · 10:40
clinical Some bladders are areflexic (hold urine but don't efficiently empty), and CIC addresses this by ensuring regular complete emptying. ↗
▶ Ep 2 · 10:40
quote the concept of CIC gets around all of those things because it enables the patient to get their bladder emptied on a regular basis ↗
▶ Ep 2 · 11:10
opinion Some urologists advocate starting all children with spina bifida on CIC from birth to familiarize families, allow child acceptance, and potentially influence bladder development protectively. ↗
▶ Ep 2 · 12:20
quote there's some data now coming out that suggests if you do it early, you may actually be able to influence how that bladder develops, and you may actually improve the overall bladder dynamics as that child grows ↗
▶ Ep 2 · 12:20
clinical There is emerging data suggesting early CIC may improve overall bladder dynamics as the child grows and be protective in a proactive way. ↗
▶ Ep 2 · 12:50
clinical The traditional approach was to start CIC only in patients with worrisome features or hostile bladders on initial testing, but this may allow damage to occur before intervention. ↗
▶ Ep 2 · 13:10
quote the, the argument, I guess, you know, or the, the worry about starting it sort of Expectantly is that maybe there's already been damage done at that point, um, and you're kind of doing it on a later basis ↗
▶ Ep 2 · 14:31
clinical Strong indications for initiating CIC include bladder pressures >40 cm H₂O on urodynamics, hydronephrosis, small bladder capacity, vesicoureteral reflux, or detrusor-sphincter dyssynergia. ↗
▶ Ep 2 · 16:00
quote this is one of those entities that's really well managed in a multidisciplinary setting, because there are so many different parts of the body that, that can be involved ↗
▶ Ep 2 · 17:20
quote I think it's about patience, clear communication, um, and, and, um, Repeating, uh, what your priorities and goals are, uh, with that family and patient ↗
▶ Ep 2 · 18:03
clinical Spina bifida management is optimally done in a multidisciplinary clinic including neurosurgeon, orthopedist, neurologist, urologist, pediatric surgery, GI, social work, and developmental pediatrician, with a care coordinator to integrate plans. ↗
▶ Ep 2 · 20:38
clinical Oxybutynin (Ditropan), an anticholinergic medication, helps relax the bladder and increase compliance; in combination with CIC it is the key therapy for managing hostile bladders. ↗
▶ Ep 2 · 22:33
opinion Some suggest all spina bifida patients should be started on oxybutynin prophylactically, but there is insufficient evidence to support universal use given medication side effects. ↗
▶ Ep 2 · 23:28
clinical For stable patients, renal ultrasound should be done every 3-6 months in the first several years of life and urodynamics every 6-12 months, with closer intervals for high-risk patients or after medication changes. ↗
▶ Ep 2 · 25:50
clinical There is no hard and fast rule for how long high bladder pressures (>40 cm H₂O) can persist before causing renal damage; the timeline is unknown. ↗
▶ Ep 2 · 25:50
quote we don't know over what time period you're gonna lose kidney function. So, there's not a Hard and fast rule to say, oh, if your pressures remain above 40, this is going to lead to loss of X amount of GFR in, in what period of time. We don't know ↗
▶ Ep 2 · 27:46
clinical Vesicoureteral reflux in neurogenic bladder patients is often secondary reflux caused by abnormally high bladder pressures overwhelming the ureterovesical valve mechanism, which is a very poor prognostic sign. ↗
▶ Ep 2 · 28:20
quote the pressures within the bladder are so abnormally high that it overwhelms the valve mechanism where the ureter meets the bladder, and then you get back up. And to us, that's a very poor sign ↗
▶ Ep 2 · 28:50
clinical High-grade reflux combined with recurrent UTIs creates a dangerous situation where kidneys are exposed to both high pressure and bacterial showers, leading to pyelonephritis and scarring that damages future kidney function. ↗
▶ Ep 2 · 29:10
quote now you've got backup of a high pressure situation. So you've got, you're hammering the kidneys with high pressure, and you are potentially showering the kidneys with bacteria ↗
▶ Ep 2 · 29:40
clinical Cutaneous vesicostomy is the gold standard temporary diversion for infants with hostile bladders, high-grade reflux, and recurrent UTIs; it involves opening the bladder dome and sewing it to the skin as an incontinent stoma above the pubic bone. ↗
▶ Ep 2 · 30:50
clinical A freely draining vesicostomy prevents bladder filling, eliminates high pressure, stops reflux, and prevents pyelonephritis, though it becomes messier to manage as the child grows. ↗
▶ Ep 2 · 30:50
quote it essentially prevents the bladder from filling and so it takes care of that pressure situation. And if you take care of the pressure situation and the bladder's not filling, then no more reflux ↗
▶ Ep 2 · 31:52
clinical Vesicostomy is viewed as temporary; closure timing depends on family readiness and having a plan for subsequent bladder management, since closing it will likely recreate the original high-pressure situation. ↗
▶ Ep 2 · 33:20
clinical Continence surgery comes at a price: anything done to help a patient gain continence could adversely affect bladder function and can convert a non-hostile bladder into a hostile situation. ↗
▶ Ep 2 · 33:20
quote continence in this situation comes at a price. So, anything. That we're going to do to try to help that patient gain continence could adversely affect how their bladder, um, works ↗
▶ Ep 2 · 33:50
quote You can take a situation that was previously non-hostile and create a hostile situation based on something that you're surgically doing for that patient ↗
▶ Ep 2 · 34:40
clinical Urinary incontinence in neurogenic bladder can be multifactorial: bladder squeezing inappropriately, sphincter not opening/closing at right times, sphincter always open, or insufficient bladder capacity. ↗
▶ Ep 2 · 35:30
clinical Urinary tract reconstruction for continence can consist of augmentation cystoplasty (physically enlarging the bladder with bowel), bladder neck procedures (increasing outlet resistance), and continent catheterizable channels (providing a reliable catheterization route). ↗
▶ Ep 2 · 39:10
clinical Patient selection for reconstruction must consider mobility, hand function, cognitive status, family dynamics, and long-term independence—if parents age or the patient requires institutional care, who will manage complex catheterization? ↗
▶ Ep 2 · 39:40
quote the parents may be very excited to sign up for any and all of the procedures you're describing, but who's going to manage that? When the parent's not there ↗
▶ Ep 2 · 40:40
quote you can, can, you can. Can you can always, but should you? And for that particular patient, is that the best thing for them? ↗
▶ Ep 2 · 41:20
clinical Augmentation cystoplasty typically uses a 20-30 cm segment of detubularized ileum or colon anastomosed to a widely opened bladder to increase capacity and reduce pressure; detubularization eliminates inherent contractile properties of the bowel. ↗
▶ Ep 2 · 42:30
clinical Bladder neck procedures include rectus fascial sling (lassoing the bladder neck to tighten it), artificial sphincters, urethral lengthening procedures, or complete bladder neck closure (the most definitive way to eliminate leakage). ↗
▶ Ep 2 · 43:40
clinical The Mitrofanoff (appendicovesicostomy) uses the appendix preserved on its mesentery, tunneled into the bladder with one end to bladder and proximal end brought to skin as a catheterizable stoma. ↗
▶ Ep 2 · 44:40
clinical If no suitable appendix is available, a Yang-Monty tube can be created from a small piece of ileum that is detubularized transversely and closed longitudinally to form a catheterizable channel. ↗
▶ Ep 2 · 46:01
clinical Cystoscopic Botox injection into the detrusor muscle is increasingly offered as a minimally invasive option to paralyze overactive bladder and reduce pressure, potentially delaying or avoiding major reconstruction, though it requires repeated treatments and may not fully address continence. ↗
▶ Ep 2 · 47:30
quote Botox is a viable alternative that's being offered by many, um, to try to stave off that, that eventual need for, for surgical reconstruction ↗
▶ Ep 2 · 48:24
clinical Transition from pediatric to adult care for spina bifida patients is poorly developed at many centers, with barriers including patients getting lost to follow-up, mistrust of healthcare, and adult providers being uncomfortable managing complex congenital anomalies. ↗
▶ Ep 2 · 49:50
opinion Optimal transition requires dedicated transitional clinics starting in teenage years with gradual handoff to adult providers, and a next generation of adult specialists interested in congenital urology and reconstruction. ↗
Lynn's statements about Spina Bifida 53 statements

Open the Spina Bifida collection →

Neurogenic Bladder

▶ Ep 3 · 1:06
quote Neurogenic bladder can affect a lot of different, um, um, disease states, and so we always think of spina bifida as probably the most common cause in our PES populations, but, um, truth be told, you can see neurogenic bladder, you know, in children with any spinal cord abnorm. Abnormality, a spinal cord injury, certainly after trauma ↗
▶ Ep 3 · 1:06
clinical Neurogenic bladder affects children with spinal cord abnormalities including spina bifida, spinal cord injury after trauma, cloacal exstrophy, anorectal malformations, and VACTERL complex with known spinal cord problems. ↗
▶ Ep 3 · 2:34
clinical Baseline evaluation for newborns with myelomeningocele includes renal bladder ultrasound and VCUG to assess for two kidneys, hydronephrosis, bladder shape, trabeculations, reflux, and bladder neck/urethral contour. ↗
▶ Ep 3 · 4:49
clinical The majority of children with spina bifida will have very normal imaging studies at birth, making baseline pictures important for tracking changes. ↗
▶ Ep 3 · 5:12
clinical Urodynamics should be performed within the first month or couple of months of life to measure bladder pressure and compliance during filling. ↗
▶ Ep 3 · 6:00
quote a normal bladder should be a low pressure kind of situation as it fills, the compliance should be good, meaning that the change in the pressure as the volume changes should be very, very little, and that's the hallmark of a normal bladder ↗
▶ Ep 3 · 6:00
clinical A normal bladder should be low pressure during filling with good compliance (minimal pressure change as volume increases); pathologic or neuropathic bladders tend to have higher pressures, which is the most dangerous thing to the kidneys. ↗
▶ Ep 3 · 6:50
clinical A hostile bladder is defined as having high pressure, demonstrating signs of instability, or contracting during filling (when it should be quiet and relaxed). ↗
▶ Ep 3 · 6:50
quote hostile is a term we'll use too to indicate that the bladder has a high pressure, that the bladder is demonstrating signs of instability or it's contracting, um, during the filling, which is abnormal ↗
▶ Ep 3 · 7:30
clinical Detrusor-sphincter dyssynergia (DSD) is a discoordination between the bladder and sphincter seen in neurogenic bladder, where the sphincter fails to relax during bladder contraction, creating a high-pressure situation that can damage kidneys over time. ↗
▶ Ep 3 · 8:10
quote for a normal person, when you go to void, your sphincter knows to relax and open so that. There's no resistance to that at all. But when you get into a situation where things are discoordinated, and one part of the bladder doesn't know what the other part of the bladder's doing, you can imagine that voiding, or trying to contract your bladder while the sphincter is still tight and closed, um, can lead to another high pressure situation ↗
▶ Ep 3 · 9:00
clinical DSD can occur in any neurogenic bladder situation including spinal cord injury or trauma, not just spina bifida. ↗
▶ Ep 3 · 9:37
clinical Clean intermittent catheterization (CIC) is the mainstay of management for neurogenic bladder patients, enabling complete bladder emptying, reducing pressure, and bypassing sphincter dysfunction. ↗
▶ Ep 3 · 10:40
clinical Some bladders are areflexic (hold urine but don't efficiently empty), and CIC addresses this by ensuring regular complete emptying. ↗
▶ Ep 3 · 10:40
quote the concept of CIC gets around all of those things because it enables the patient to get their bladder emptied on a regular basis ↗
▶ Ep 3 · 11:10
opinion Some urologists advocate starting all children with spina bifida on CIC from birth to familiarize families, allow child acceptance, and potentially influence bladder development protectively. ↗
▶ Ep 3 · 12:20
clinical There is emerging data suggesting early CIC may improve overall bladder dynamics as the child grows and be protective in a proactive way. ↗
▶ Ep 3 · 12:20
quote there's some data now coming out that suggests if you do it early, you may actually be able to influence how that bladder develops, and you may actually improve the overall bladder dynamics as that child grows ↗
▶ Ep 3 · 12:50
clinical The traditional approach was to start CIC only in patients with worrisome features or hostile bladders on initial testing, but this may allow damage to occur before intervention. ↗
▶ Ep 3 · 13:10
quote the, the argument, I guess, you know, or the, the worry about starting it sort of Expectantly is that maybe there's already been damage done at that point, um, and you're kind of doing it on a later basis ↗
▶ Ep 3 · 14:31
clinical Strong indications for initiating CIC include bladder pressures >40 cm H₂O on urodynamics, hydronephrosis, small bladder capacity, vesicoureteral reflux, or detrusor-sphincter dyssynergia. ↗
▶ Ep 3 · 16:00
quote this is one of those entities that's really well managed in a multidisciplinary setting, because there are so many different parts of the body that, that can be involved ↗
▶ Ep 3 · 17:20
quote I think it's about patience, clear communication, um, and, and, um, Repeating, uh, what your priorities and goals are, uh, with that family and patient ↗
▶ Ep 3 · 18:03
clinical Spina bifida management is optimally done in a multidisciplinary clinic including neurosurgeon, orthopedist, neurologist, urologist, pediatric surgery, GI, social work, and developmental pediatrician, with a care coordinator to integrate plans. ↗
▶ Ep 3 · 20:38
clinical Oxybutynin (Ditropan), an anticholinergic medication, helps relax the bladder and increase compliance; in combination with CIC it is the key therapy for managing hostile bladders. ↗
▶ Ep 3 · 22:33
opinion Some suggest all spina bifida patients should be started on oxybutynin prophylactically, but there is insufficient evidence to support universal use given medication side effects. ↗
▶ Ep 3 · 23:28
clinical For stable patients, renal ultrasound should be done every 3-6 months in the first several years of life and urodynamics every 6-12 months, with closer intervals for high-risk patients or after medication changes. ↗
▶ Ep 3 · 25:50
quote we don't know over what time period you're gonna lose kidney function. So, there's not a Hard and fast rule to say, oh, if your pressures remain above 40, this is going to lead to loss of X amount of GFR in, in what period of time. We don't know ↗
▶ Ep 3 · 25:50
clinical There is no hard and fast rule for how long high bladder pressures (>40 cm H₂O) can persist before causing renal damage; the timeline is unknown. ↗
▶ Ep 3 · 27:46
clinical Vesicoureteral reflux in neurogenic bladder patients is often secondary reflux caused by abnormally high bladder pressures overwhelming the ureterovesical valve mechanism, which is a very poor prognostic sign. ↗
▶ Ep 3 · 28:20
quote the pressures within the bladder are so abnormally high that it overwhelms the valve mechanism where the ureter meets the bladder, and then you get back up. And to us, that's a very poor sign ↗
▶ Ep 3 · 28:50
clinical High-grade reflux combined with recurrent UTIs creates a dangerous situation where kidneys are exposed to both high pressure and bacterial showers, leading to pyelonephritis and scarring that damages future kidney function. ↗
▶ Ep 3 · 29:10
quote now you've got backup of a high pressure situation. So you've got, you're hammering the kidneys with high pressure, and you are potentially showering the kidneys with bacteria ↗
▶ Ep 3 · 29:40
clinical Cutaneous vesicostomy is the gold standard temporary diversion for infants with hostile bladders, high-grade reflux, and recurrent UTIs; it involves opening the bladder dome and sewing it to the skin as an incontinent stoma above the pubic bone. ↗
▶ Ep 3 · 30:50
quote it essentially prevents the bladder from filling and so it takes care of that pressure situation. And if you take care of the pressure situation and the bladder's not filling, then no more reflux ↗
▶ Ep 3 · 30:50
clinical A freely draining vesicostomy prevents bladder filling, eliminates high pressure, stops reflux, and prevents pyelonephritis, though it becomes messier to manage as the child grows. ↗
▶ Ep 3 · 31:52
clinical Vesicostomy is viewed as temporary; closure timing depends on family readiness and having a plan for subsequent bladder management, since closing it will likely recreate the original high-pressure situation. ↗
▶ Ep 3 · 33:20
clinical Continence surgery comes at a price: anything done to help a patient gain continence could adversely affect bladder function and can convert a non-hostile bladder into a hostile situation. ↗
▶ Ep 3 · 33:20
quote continence in this situation comes at a price. So, anything. That we're going to do to try to help that patient gain continence could adversely affect how their bladder, um, works ↗
▶ Ep 3 · 33:50
quote You can take a situation that was previously non-hostile and create a hostile situation based on something that you're surgically doing for that patient ↗
▶ Ep 3 · 34:40
clinical Urinary incontinence in neurogenic bladder can be multifactorial: bladder squeezing inappropriately, sphincter not opening/closing at right times, sphincter always open, or insufficient bladder capacity. ↗
▶ Ep 3 · 35:30
clinical Urinary tract reconstruction for continence can consist of augmentation cystoplasty (physically enlarging the bladder with bowel), bladder neck procedures (increasing outlet resistance), and continent catheterizable channels (providing a reliable catheterization route). ↗
▶ Ep 3 · 39:10
clinical Patient selection for reconstruction must consider mobility, hand function, cognitive status, family dynamics, and long-term independence—if parents age or the patient requires institutional care, who will manage complex catheterization? ↗
▶ Ep 3 · 39:40
quote the parents may be very excited to sign up for any and all of the procedures you're describing, but who's going to manage that? When the parent's not there ↗
▶ Ep 3 · 40:40
quote you can, can, you can. Can you can always, but should you? And for that particular patient, is that the best thing for them? ↗
▶ Ep 3 · 41:20
clinical Augmentation cystoplasty typically uses a 20-30 cm segment of detubularized ileum or colon anastomosed to a widely opened bladder to increase capacity and reduce pressure; detubularization eliminates inherent contractile properties of the bowel. ↗
▶ Ep 3 · 42:30
clinical Bladder neck procedures include rectus fascial sling (lassoing the bladder neck to tighten it), artificial sphincters, urethral lengthening procedures, or complete bladder neck closure (the most definitive way to eliminate leakage). ↗
▶ Ep 3 · 43:40
clinical The Mitrofanoff (appendicovesicostomy) uses the appendix preserved on its mesentery, tunneled into the bladder with one end to bladder and proximal end brought to skin as a catheterizable stoma. ↗
▶ Ep 3 · 44:40
clinical If no suitable appendix is available, a Yang-Monty tube can be created from a small piece of ileum that is detubularized transversely and closed longitudinally to form a catheterizable channel. ↗
▶ Ep 3 · 46:01
clinical Cystoscopic Botox injection into the detrusor muscle is increasingly offered as a minimally invasive option to paralyze overactive bladder and reduce pressure, potentially delaying or avoiding major reconstruction, though it requires repeated treatments and may not fully address continence. ↗
▶ Ep 3 · 47:30
quote Botox is a viable alternative that's being offered by many, um, to try to stave off that, that eventual need for, for surgical reconstruction ↗
▶ Ep 3 · 48:24
clinical Transition from pediatric to adult care for spina bifida patients is poorly developed at many centers, with barriers including patients getting lost to follow-up, mistrust of healthcare, and adult providers being uncomfortable managing complex congenital anomalies. ↗
▶ Ep 3 · 49:50
opinion Optimal transition requires dedicated transitional clinics starting in teenage years with gradual handoff to adult providers, and a next generation of adult specialists interested in congenital urology and reconstruction. ↗