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Bladder function in patients with lipomyelomeningocele
L S Foster1, B A Kogan, P H Cogen
1Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Insights
Early surgical correction of lipomyelomeningocele can improve bladder function. Prompt neurosurgical intervention may prevent or reverse bladder dysfunction in young patients.
Area of Science:
- Pediatric Urology
- Neuroscience
- Developmental Biology
Background:
- Lipomyelomeningocele is a congenital spinal cord malformation.
- Bladder dysfunction is a common complication in patients with lipomyelomeningocele.
Purpose of the Study:
- To evaluate the impact of operative correction on bladder function in patients with lipomyelomeningocele.
- To determine the effectiveness of early neurosurgical intervention in preventing or reversing bladder dysfunction.
Main Methods:
- Prospective evaluation of 31 patients undergoing lipomyelomeningocele repair.
- Preoperative and postoperative assessment of bladder function using urodynamic studies.
- Analysis of bladder function based on patient age at operation.
Main Results:
- In patients under 1.5 years, 42% had normal bladder function postoperatively, and 33% normalized.
- In patients over 1.5 years, only 21% had normal bladder function postoperatively, with no normalization.
- Abnormal urodynamic findings were the sole indicator of neurological abnormality in 42% of younger patients.
Conclusions:
- Lipomyelomeningocele is frequently associated with bladder dysfunction.
- Early neurosurgical intervention can prevent or reverse bladder dysfunction in select cases.
- Urodynamic assessment is crucial for neurological evaluation and patient management.
Abstract:
We evaluated preoperative and postoperative bladder function in 31 consecutive patients who underwent definitive operative correction of lipomyelomeningocele. Of 12 patients less than 1.5 years old at operation, bladder function was normal preoperatively and postoperatively in 5 (42%) and normalized postoperatively in 4 (33%). In 5 patients (42%) abnormal urodynamic findings were the only sign of neurological abnormality. Of the 19 patients older than 1.5 years at operation bladder function was normal preoperatively and postoperatively in only 4 (21%), and normalized postoperatively in none. We conclude that the majority of patients with lipomyelomeningocele have bladder dysfunction, and that in some cases this dysfunction can be prevented and/or reversed by early neurosurgical intervention. Urodynamic assessment is helpful as part of the neurological evaluation and in directing patient care.