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Nonsurgical Management of Threatened Upper Urinary Tracts and Incontinence in Children with Myelomeningocele

1994; Lippincott Williams & Wilkins; Volume: 152; Issue: 5 Part 1 Linguagem: Inglês

10.1016/s0022-5347(17)32480-1

1527-3792

Reynaldo D. Hernandez, Richard S. Hurwitz, Jenelle E. Foote, Philippe E. Zimmern, Gary E. Leach,

Ureteral procedures and complications

No AccessJournal of Urology1 Nov 1994Nonsurgical Management of Threatened Upper Urinary Tracts and Incontinence in Children with Myelomeningocele Reynaldo D. Hernandez, Richard S. Hurwitz, Jenelle E. Foote, Philippe E. Zimmern, and Gary E. Leach Reynaldo D. HernandezReynaldo D. Hernandez More articles by this author , Richard S. HurwitzRichard S. Hurwitz More articles by this author , Jenelle E. FooteJenelle E. Foote More articles by this author , Philippe E. ZimmernPhilippe E. Zimmern More articles by this author , and Gary E. LeachGary E. Leach More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)32480-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The 2 major urological objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. We report our success in managing these cases with nonsurgical therapy. From 1981 to 1991, 45 patients with myelomeningocele 1 to 15 years old were evaluated urodynamically before and after initiating nonsurgical treatment. Pretreatment urodynamics identified 2 groups. Group 1 consisted of 31 patients with leak point pressure of 40cm. water or more of whom 10 had grades II to V/V vesicoureteral reflux and 4 had moderate or severe hydronephrosis. Group 2 consisted of 14 incontinent patients with leak point pressure of less than 40 cm. water and no reflux or hydronephrosis. Both groups were treated with intermittent catheterization, anticholinergic medications and fluid restriction. Within a mean followup of 5.5 years nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm. water in 22 of 31 group 1 patients (71%), and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patients. Of 4 patients in group 1 with persistent high grade vesicoureteral reflux or severe hydronephrosis 3 (10%) required augmentation cystoplasty. With nonsurgical management 18 patients (40%) were completely continent, 18 (40%) required 2 or less pads daily and 9 (20%) required more than 2 pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory with nonsurgical management. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByNaqvi S, Clothier J, Wright A and Garriboli M (2019) Urodynamic Outcomes in Children after Single and Multiple Injections for Overactive and Low Compliance Neurogenic Bladder Treated with Abobotulinum Toxin AJournal of Urology, VOL. 203, NO. 2, (413-419), Online publication date: 1-Feb-2020.Pascali M, Mosiello G, Boldrini R, Salsano M, Castelli E and De Gennaro M (2011) Effects of Botulinum Toxin Type A in the Bladder Wall of Children With Neurogenic Bladder Dysfunction: A Comparison of Histological Features Before and After InjectionsJournal of Urology, VOL. 185, NO. 6S, (2552-2557), Online publication date: 1-Jun-2011.Pascali M, Mosiello G, Marciano A, Capitanucci M, Zaccara A and De Gennaro M (2011) A Simplified Technique for Botulinum Toxin Injections in Children With Neurogenic BladderJournal of Urology, VOL. 185, NO. 6S, (2558-2562), Online publication date: 1-Jun-2011.Neel K, Soliman S, Salem M, Seida M, Al-Hazmi H and Khatab A (2018) Botulinum-A Toxin: Solo Treatment for Neuropathic Noncompliant BladderJournal of Urology, VOL. 178, NO. 6, (2593-2598), Online publication date: 1-Dec-2007.Riccabona M, Koen M, Schindler M, Goedele B, Pycha A and Lusuardi L (2018) Botulinum-A Toxin Injection Into the Detrusor: A Safe Alternative in the Treatment of Children With Myelomeningocele With Detrusor HyperreflexiaJournal of Urology, VOL. 171, NO. 2, (845-848), Online publication date: 1-Feb-2004.TANAKA H, KAKIZAKI H, KOBAYASHI S, SHIBATA T, AMEDA K and KOYANAGI T (2018) THE RELEVANCE OF URETHRAL RESISTANCE IN CHILDREN WITH MYELODYSPLASIA: ITS IMPACT ON UPPER URINARY TRACT DETERIORATION AND THE OUTCOME OF CONSERVATIVE MANAGEMENTJournal of Urology, VOL. 161, NO. 3, (929-932), Online publication date: 1-Mar-1999.BUYSE G, VERPOORTEN C, VEREECKEN R and CASAER P (2018) INTRAVESICAL APPLICATION OF A STABLE OXYBUTYNIN SOLUTION IMPROVES THERAPEUTIC COMPLIANCE AND ACCEPTANCE IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTIONJournal of Urology, VOL. 160, NO. 3 Part 2, (1084-1087), Online publication date: 1-Sep-1998.Kim Y, Bird E, Priebe M and Boone T (2018) THE ROLE OF OXYBUTYNIN IN SPINAL CORD INJURED PATIENTS WITH INDWELLING CATHETERSJournal of Urology, VOL. 158, NO. 6, (2083-2086), Online publication date: 1-Dec-1997.Agarwal S, McLorie G, Grewal D, Joyner B, Bagli D and Khoury A (2018) Urodynamic Correlates of Resolution of Reflux in Meningomyelocele PatientsJournal of Urology, VOL. 158, NO. 2, (580-582), Online publication date: 1-Aug-1997.Edelstein R, Bauer S, Kelly M, Darbey M, Peters C, Atala A, Mandell J, Colodny A and Retik A (2018) Long-Term Urological Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic TherapyJournal of Urology, VOL. 154, NO. 4, (1500-1504), Online publication date: 1-Oct-1995. Volume 152Issue 5 Part 1November 1994Page: 1582-1585 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsvesico-ureteral refluxmeningomyeloceleurinary incontinenceurinary tracthydronephrosisMetricsAuthor Information Reynaldo D. Hernandez More articles by this author Richard S. Hurwitz More articles by this author Jenelle E. Foote More articles by this author Philippe E. Zimmern More articles by this author Gary E. Leach More articles by this author Expand All Advertisement PDF DownloadLoading ...