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The incontinent myelodysplastic patient
1University of Texas Medical School, Houston.
Insights
Urinary incontinence in myelodysplastic children requires urodynamic assessment to determine the cause. Tailored treatments, including devices and surgery, help achieve social continence and protect kidney function.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder
- Spinal Dysraphism
Background:
- Urinary incontinence significantly impacts the quality of life for children with myelodysplastic conditions.
- The precise cause of vesicourethral dysfunction is not predictable from the spinal defect level or neurological deficits.
Purpose of the Study:
- To emphasize the necessity of urodynamic assessment for accurate diagnosis of bladder dysfunction in myelodysplastic children.
- To outline a comprehensive approach to managing urinary incontinence in this population.
Main Methods:
- Urodynamic assessment to precisely identify altered bladder storage and urethral sphincter function.
- Review of various therapeutic options including conservative, pharmacologic, and surgical interventions.
- Emphasis on individualized treatment planning and long-term urological follow-up.
Main Results:
- Urodynamic evaluation is crucial for differentiating between abnormal bladder storage and urethral incompetence.
- A multi-modal treatment strategy can be tailored to individual patient needs.
- Consistent follow-up is key to successful management.
Conclusions:
- Comprehensive urodynamic assessment is essential for guiding effective treatment of urinary incontinence in myelodysplastic children.
- Individualized, long-term management strategies are vital for achieving social continence and preserving renal health.
Abstract:
Urinary incontinence is a socially devastating aspect of the lives of many myelodysplastic children. Incontinence results from abnormal bladder storage function, urethral sphincteric incompetence, or both. Unfortunately, the vesicourethral dysfunction in an individual patient cannot be discerned from the level of the vertebral defect or the coexisting neurologic deficits. Therefore, thorough urodynamic assessment is required to identify altered physiology precisely and to guide rational treatment. Our therapeutic armamentarium includes external devices, intermittent self-catheterization, pharmacologic therapy, prosthetics, electrical stimulation, biofeedback, and innovative surgical procedures. Comprehensive evaluation, thoughtful tailoring of therapy to the individual patient, and a commitment by the urologist to indefinite follow-up will enable most patients to attain social continence while preserving renal function.