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Current management of the infant with myelomeningocele
1Texas Children's Hospital, Houston 77030-2399, USA.
Insights
Managing newborns with myelomeningocele presents challenges for urologists. This review addresses key questions regarding diagnostic imaging, bladder management, surgical interventions, and urodynamics to minimize long-term complications.
Area of Science:
- Pediatric Urology
- Neonatal Surgery
- Spinal Cord Malformations
Background:
- Myelomeningocele poses significant urological challenges in newborns.
- Optimal management strategies for these infants remain a subject of ongoing discussion among specialists.
Purpose of the Study:
- To address critical questions in the management of neonates with myelomeningocele.
- To provide guidance on diagnostic and therapeutic interventions to improve long-term outcomes.
Main Methods:
- Review of current literature and clinical practices.
- Discussion of diagnostic imaging modalities and their timing.
- Evaluation of methods for assessing bladder drainage adequacy.
- Overview of surgical options and urodynamic assessment indications.
Main Results:
- The timing and type of radiologic studies are crucial for early diagnosis.
- Regular assessment of bladder drainage is necessary to guide treatment.
- Surgical interventions are tailored to specific urological issues.
- Urodynamics plays a role in evaluating bladder function at appropriate intervals.
Conclusions:
- A comprehensive and timely management approach for newborns with myelomeningocele is essential.
- Early and appropriate interventions significantly impact the reduction of long-term morbidity.
- Multidisciplinary care is vital for optimizing outcomes in this patient population.
Abstract:
Infants with myelomeningocele continue to be a management dilemma for urologists. This article discusses many of the current questions that surround the newborn with myelomeningocele. What radiologic studies should be performed and when? How does the clinician determine if bladder drainage is adequate or requires altering? If a problem is identified what are the surgical options? When should urodynamics be performed? Ultimately how one manages, follows and initiates treatments in the newborn will have a significant effect on the long-term morbidity seen in this population of children.