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Initial urological evaluation and management of children with neurogenic bladder due to myelomeningocele

2017; Elsevier BV; Volume: 13; Issue: 3 Linguagem: Inglês

10.1016/j.jpurol.2016.12.024

1873-4898

Cristian Sager, Carol Burek, Juan Pablo Corbetta, Santiago Weller, Javier Ruíz, Ramiro Perea, Enrique Lago, Yesica Gomez, Víctor Durán, Juan Carlos López,

Urological Disorders and Treatments

The proactive management of children with myelomeningocele (MMC) has contributed to decreasing their progression to end-stage renal disease, thanks to early urological evaluation and timing implementation of treatments.To demonstrate that early urological evaluation of the urinary tract in MMC shows functional alterations in most cases, and that it requires medical intervention, even when in some cases the complementary imaging studies do not show any abnormalities.A retrospective study including 60 patients aged 20 cm H2O, 43.3%; inefficient bladder voiding, 98.3%; indirect dyssynergic patterns, 28.8%. The high-risk videourodynamic findings were observed in 28 cases (46.6%). DMSA was abnormal in 30%. Renal impairment was detected in 6.6% of cases. A total of 66% of cases received oxybutynin.Almost all the children in this sample population showed urinary dysfunction, and approximately half of them had high-risk videourodynamic findings. Although many cases showed reflex urinary contractions, almost the entire sample had inefficient bladder voiding. An important limitation of this work was the lack of simultaneity in obtaining each of the requested studies.In the initial urological evaluation of patients with myelomeningocele, almost all the urodynamic studies showed abnormalities and one-third showed abnormal DMSA, which led to therapeutic actions being initiated, although imaging studies were normal in a great number of patients. CIC alone, starting immediately after birth, is not sufficient. To eliminate or decrease upper tract damage, oxybutynin should be started in addition.