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[Urinary calculi in myelomeningocele adults]
F Verdú Tartajo1, J Salinas Casado, F Herranz Amo
1Servicio de Urologia, Hospital Universitario Gregorio Marañón, Madrid. ferverdu@pulso.com
Insights
Urinary lithiasis is common in adults with myelomeningocele (MMC). Management presents unique challenges due to patient-specific anatomy and treatments, impacting diagnosis, therapy, and prevention strategies.
Area of Science:
- Urology
- Neurosurgery
- Pediatric Surgery
Context:
- Improved survival rates for myelomeningocele (MMC) patients have led to an increasing adult population.
- Limited data exists on urological conditions, specifically urinary lithiasis, in adults with MMC.
Purpose:
- To evaluate the characteristics of urinary lithiasis in adults with MMC.
- To analyze the treatment modalities employed for urinary calculi in this patient cohort.
Summary:
- A review of 52 adult MMC patients (18-40 years) found 19.2% had urolithiasis, with bladder calculi being more prevalent (15.3%) than kidney calculi.
- Neurological levels varied, and neurogenic bladder dysfunction types included lower motor neurone, upper motor neurone, and mixed lesions.
- Treatments involved endoscopic procedures, suprapubic cystolithotomy, and in one case, ESWL and percutaneous nephrolithotomy; recurrences were noted in three patients.
Impact:
- Urinary lithiasis is a significant concern in adult MMC survivors.
- The anatomical and therapeutic specificities of MMC patients pose diagnostic, therapeutic, and prophylactic challenges for stone management.
- Further research is needed to optimize the long-term urological care of adults with MMC.
Introduction And Objectives:
The improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment.
Material And Method:
We review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years.
Results:
10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was < or = L2 in 3 cases, L2-S1 in 5, and > or = S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional AMS-800 artificial urinary sphincter. Bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of AMS-800 in 3 of them. One patient spontaneously passed a small stone. In one case, 2 ESWL and 2 percutaneous nephrolithotomies were needed. Three patients developed multiple recurrences during follow-up.
Conclusions:
Urinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop.
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