Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia: a followup study

We report on 6 patients with myelodysplasia who had undergone previously urodynamic evaluation that demonstrated detrusor hypertonia. At the time of the initial studies no patient had vesicoureteral reflux or significant upper urinary tract dilatation. Subsequently, upper urinary tract deterioration and/or vesicoureteral reflux developed in all patients and persisting detrusor hypertonia was demonstrated on followup urodynamic testing. Marked clinical and radiographic improvement followed treatment by intermittent catheterization with concomitant pharmacologic therapy. Our experience indicates that detrusor hypertonia can lead to ureteral complications in patients with previously radiographically normal upper urinary tracts. We believe that detrusor hypertonia should be treated with anticholinergic medication, frequently in conjunction with intermittent catheterization. The clinical presentation of upper tract deterioration after many years of normality, and occurring as late as the mid teenage years, demonstrates that these patients require prolonged and careful urologic and radiographic followup.