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Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with
Thomas M Kessler1, Jakob Lackner, Gustav Kiss
1Neuro-Urology Unit, Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria.
Insights
Early neurourological management for myelomeningocele patients significantly improves long-term upper urinary tract function. Proactive intervention, ideally from birth, reduces the need for surgical procedures.
Area of Science:
- Pediatric Urology
- Neuro-urology
- Spina Bifida Research
Background:
- Myelomeningocele is a complex congenital condition affecting neural development.
- Urinary tract dysfunction is a common and serious complication in myelomeningocele patients.
- The timing of neurourological management may influence outcomes.
Purpose of the Study:
- To determine if the timing of initiating neurourological management impacts upper urinary tract function in myelomeningocele patients.
- To assess if early intervention affects the requirement for surgical procedures to preserve upper urinary tract function.
Main Methods:
- Retrospective study of 133 myelomeningocele patients.
- Patients categorized into three groups based on age at initial evaluation: birth to 2 years, 3 to 10 years, and after 10 years.
- Comparison of upper urinary tract function and surgical intervention rates across groups.
Main Results:
- Long-term follow-up showed significantly better upper urinary tract function in the early management group (99% vs. 86% and 86%).
- The need for surgery to preserve upper urinary tract function was significantly lower in the early group (15% vs. 34% and 59%).
- Initial upper urinary tract function was similar across groups, but divergence occurred over time.
Conclusions:
- Early, proactive neurourological management is crucial for maintaining upper urinary tract function in myelomeningocele.
- Initiating management from birth significantly reduces the long-term need for surgical intervention.
- Timely neurourological care is essential for optimizing outcomes in pediatric patients with myelomeningocele.
Aims:
To investigate whether upper urinary tract function and the need for surgery in patients with myelomeningocele depends on the timing of initiating neurourological management.
Patients And Methods:
One hundred thirty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on age at the initial evaluation into three categories: from day of birth to age 2 (group 1, n = 67), from age 3 to age 10 (group 2, n = 44), and after age 10 (group 3, n = 22). Upper urinary tract function and the need for surgery with the intention to preserve or normalize the upper urinary tract function were compared between the three groups.
Results:
Mean follow-up was 11, 10, and 9 years in group 1, 2, and 3, respectively. The upper urinary tract function was normal in 91%, 80%, and 82% at the initial evaluation (P = 0.194) and in 99%, 86%, and 86% at the last follow-up (P = 0.012) in group 1, 2, and 3, respectively. Following failure of conservative therapy only, the proportions of patients undergoing surgical interventions with the intention to preserve or normalize the upper urinary tract function was significantly (P = 0.0002) different among the three groups: 15%, 34%, and 59%, respectively.
Conclusions:
Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele in the long-term. Therefore, initiation of proactive neurourological management as early as possible, ideally from the day of birth, is strongly recommended.
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