Sphincter behaviour in myelomeningocele

Area of Science:

• Pediatric Urology
• Neurology
• Urodynamics

Background:

• Myelomeningocele frequently causes neuropathic vesicourethral dysfunction.
• Understanding bladder and sphincter behavior is crucial for managing these complex conditions.

Purpose of the Study:

• To analyze the urodynamic characteristics of the bladder neck and distal sphincter mechanism in children with myelomeningocele.
• To correlate bladder and sphincter function with different urodynamic groups.

Main Methods:

• Videourodynamic studies were conducted on 207 children with myelomeningocele.
• Children were categorized into contractile, intermediate, and acontractile bladder groups.
• Bladder neck and distal sphincter function were assessed in each group.

Main Results:

• In contractile bladders, the bladder neck can be competent or incompetent but not obstructive; the distal sphincter is typically dynamically obstructive (detrusor-sphincter dyssynergia).
• In intermediate and acontractile bladders, the bladder neck is always incompetent, and both static distal sphincter obstruction and sphincter weakness incontinence can coexist.
• Sphincter mechanism dysfunction is the norm in congenital cord lesions, with potential masking of certain conditions.

Conclusions:

• Dysfunction of the bladder neck and/or distal sphincter mechanism is a consistent finding in children with congenital cord lesions and myelomeningocele.
• The specific type of sphincter dysfunction varies depending on the bladder's urodynamic behavior (contractile, intermediate, acontractile).
• Recognizing and addressing these sphincter dysfunctions is essential for effective management.