Urological outcome after myelomeningocele: 20 years of follow-up
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Published on: July 18, 2025
Jorgen Thorup1, Fin Biering-Sorensen, Dina Cortes
1Department of Pediatric Surgery and Clinic for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark. j-thorup@rh.dk
Insights
Long-term follow-up of myelomeningocele patients shows 15% kidney impairment and 48% urinary continence. Childhood urodynamics predicted later kidney deterioration, highlighting the importance of early assessment.
Area of Science:
- Urology
- Pediatric Nephrology
- Spina Bifida Research
Background:
- Myelomeningocele (spina bifida) frequently leads to complex urological issues.
- Long-term outcomes and predictors of renal function and continence in adults with myelomeningocele require further investigation.
Purpose of the Study:
- To assess the long-term urological outcomes in adults with a history of myelomeningocele.
- To correlate childhood urodynamic findings with adult renal function and urinary continence.
Main Methods:
- Retrospective analysis of 52 myelomeningocele patients (born 1964-1988) with childhood urodynamic data.
- Assessment of renal function using renography and isotope-glomerular filtration rate at childhood and long-term follow-up (median age 29 years).
- Classification of detrusor and urethral function based on urodynamic parameters and leak point pressure.
Main Results:
- 15% of patients exhibited kidney function impairment at long-term follow-up.
- 48% of individuals achieved urinary continence, with various management strategies employed (surgery, medication, catheterization).
- Childhood detrusor overactivity was significantly associated with bilateral kidney deterioration in adulthood.
Conclusions:
- Long-term urological outcomes in myelomeningocele patients show a notable rate of kidney impairment and achievable urinary continence.
- Childhood urodynamic findings are predictive of subsequent renal deterioration, emphasizing the value of early diagnostic evaluations.
- The findings support the comparability of outcomes to existing literature and underscore the importance of proactive urological management in this population.
Objective:
• To evaluate the urological outcome in a long-term follow-up of individuals with myelomeningocele and relate the findings obtained to urodynamic variables in childhood.
Patients And Methods:
• Individuals with myelomeningocele born from 1964-1988 were included at time of urodynamic investigation. • Age at inclusion was in the range from 1 month to 19.5 years (median, 6 years). • Detrusor function was classified as overactive, underactive or non-contractile. • Urethral function was classified according to the leak point pressure. • In childhood and at follow-up, kidney function was estimated with renography and isotope-glomerular filtration rate examinations.
Results:
• In total, 52 individuals (28 boys and 24 girls) aged 19-41 years (median, 29 years) had follow-up. • Of these, 37 (71%) individuals had bilateral normal kidney function at follow-up; seven (14%) had normal total renal function but unilateral deteriorated kidney, and eight individuals (15%) had deteriorated kidney function. • Adult individuals with bilateral kidney deterioration had a significant higher frequency of diagnosed detrusor overactivity at childhood urodynamics (63%) compared to those with normal function of both kidneys (24%). In total, 48% of the 52 myelomeningocele individuals were continent at follow-up. • Continence surgery was performed in eight patients, nine used anticholinergica, three had regular botulinum toxin detrusor injections, and 27 used clean intermittent catheterization.
Conclusions:
• Overall, 15% of patients had impairment of kidney function and 48% were urinary continent. • Considering the present age distribution of the present study population, this figure appears to be comparable to the data in the literature. • Urodynamic findings in childhood were predictive for later kidney deterioration.
