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Incidence of urinary tract complications with myelomeningocele
Insights
Children with myelomeningocele often develop urinary tract complications like infections and reflux. Pelvic floor muscle innervation, even slight, significantly increases risks of upper tract changes and reflux in early childhood.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder
- Spina Bifida Research
Background:
- Myelomeningocele presents significant neurological challenges in early childhood.
- Urinary tract complications are a major cause of morbidity in children with myelomeningocele.
- Understanding the early incidence and risk factors for these complications is crucial for management.
Purpose of the Study:
- To evaluate the incidence of urinary tract complications in children with myelomeningocele.
- To identify factors associated with the development of upper tract changes.
- To assess the relationship between pelvic floor muscle innervation and urinary tract morbidity.
Main Methods:
- Prospective evaluation of 258 children with myelomeningocele before surgical or catheter intervention.
- Assessment of urinary tract infection (UTI), vesicoureteral reflux (VUR), upper tract dilatation, and urinary incontinence.
- Correlation of urinary tract outcomes with the degree of pelvic floor muscle denervation.
Main Results:
- High incidence of urinary incontinence (87%) and VUR (34%) across all ages.
- UTI incidence was 26%, and upper tract dilatation was 18%.
- Slight to moderate pelvic floor denervation was associated with significantly higher rates of VUR (38%) and upper tract dilatation (54%) compared to complete denervation.
Conclusions:
- Urinary tract complications are highly prevalent in myelomeningocele patients.
- Incoordinate detrusor/sphincter activity due to partial pelvic floor innervation is a key factor in upper tract changes.
- Early identification and management of these urinary issues are critical, particularly within the first four years of life.
Abstract:
Children born with myelomeningocele face the morbidity of urinary tract complications after they have survived the neurologic complications of the first years of life. The incidence of urinary tract complications was evaluated in 258 children before any operation or intermittent catheter management was performed. In 119 children under one year of age the incidence of urinary tract infection of more than 10(5) colonies was 23 per cent, reflux was 22 per cent, and upper tract dilatation was 6 per cent. In children of all ages the incidence of urinary tract infection of more than 10(5) colonies was 26 per cent, reflux 34 per cent, upper tract dilatation 18 per cent, and urinary incontinence 87 per cent. In 11 children with complete denervation of the pelvic floor muscles reflux developed in 2 (18%) and upper tract dilatation in 1 (9%). In 13 children with slight or moderate denervation of the pelvic floor muscles reflux developed in 5 (38%) and upper tract dilatation in 7 (54%). The development of upper tract changes with myelomeningocele was mainly related to some innervation of the pelvic floor muscles (including periurethral striated muscle) with incoordinate detrusor/sphincter activity. These changes mainly occurred in the first two to four years of life.