Urological outcome of patients with cervical and upper thoracic myelomeningocele
L M Pérez1, J T Wilbanks, D B Joseph
1Sections of Pediatric Urology and Pediatric Neurosurgery, Divisions of Urology and Neurosurgery, Department of Surgery, Children's Hospital, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Purpose:
We determined the incidence of voiding disorders and upper tract deterioration in children with cervical and upper thoracic level myelomeningocele.
Materials And Methods:
We retrospectively reviewed the neurosurgical and urological presentation, evaluation and treatment of 11 patients of whom 8 had cervical and 3 had upper thoracic myelomeningocele. There were 7 female and 4 male patients 10 months to 39 years old (mean age 12 years). All patients were ambulatory and 5 of 11 (45%) had hydrocephalus. Although a voiding history was obtained by a neurosurgeon in all patients, only 9 had undergone a formal urological evaluation, including video urodynamic assessment in 5.
Results:
No patient had an increased post-void residual and none had ever been placed on intermittent catheterization. Tethered spinal cords from caudal fixation (thickened filum terminale and a lipomyelomeningocele) were present in 2 patients with urinary incontinence of whom 1 had recurrent cystitis. Imaging studies of the upper tracts were normal in all 9 patients and video urodynamics were normal in 3 of 5. No patient has required urological operative intervention.
Conclusions:
To our knowledge, this study represents the largest reported series of patients with cervical and upper thoracic myelomeningocele who have undergone urological evaluation. Our experience suggests that patients with cervical and upper thoracic myelomeningocele have a low risk of voiding disorders and upper tract deterioration unless other conditions, such as a congenital tethered cord, are present. Additional reports of children with cervical and upper thoracic myelomeningocele are necessary to confirm these findings.