Related Experiment Videos
Radiologic investigation of the urinary tract in the neonate with myelomeningocele
Insights
Neonates with myelomeningocele often have urinary tract abnormalities. Early evaluation using both excretory urograms and voiding cystourethrograms is crucial for preserving kidney function and planning for continence.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Neurosurgery
Background:
- Myelomeningocele frequently presents with congenital urinary tract abnormalities.
- Early detection and management are vital for renal preservation and future continence in affected neonates.
Purpose of the Study:
- To evaluate the diagnostic utility of excretory urograms and voiding cystourethrograms in neonates with myelomeningocele.
- To determine the incidence of urinary tract abnormalities in this population.
Main Methods:
- Retrospective review of excretory urograms and voiding cystourethrograms in 68 consecutive neonates with myelomeningocele.
- Analysis of findings to assess the correlation between the two imaging modalities.
Main Results:
- Only 30.9% of patients with normal excretory urograms had a normal voiding cystourethrogram, highlighting discordance.
- Abnormalities were detected in 80.9% of patients when both studies were considered.
- Vesicoureteral reflux was present in 16.2% of the neonates studied.
Conclusions:
- Both excretory urograms and voiding cystourethrograms are essential for a comprehensive urinary tract evaluation in neonates with myelomeningocele.
- Aggressive investigation and early therapeutic intervention are recommended to protect renal function and manage lower urinary tract issues.
Abstract:
A significant number of neonates with myelomeningocele are born with potentially damaging abnormalities of the urinary tract. Therefore, it is logical to investigate these patients aggressively and initiate therapy as early as possible to preserve renal function and maintain lower tract integrity for future continence management. Results of excretory urograms and voiding cystourethrograms were reviewed in 68 consecutive neonates with myelomeningocele. They indicate clearly that only a third of the patients with normal excretory urograms had a normal voiding cystourethrogram, which implies that both studies be performed for complete evaluation of the urinary tract. In other words, of these 68 patients 55 (80.9 per cent) had a normal excretory urogram but only 17 (30.9 per cent) had a normal voiding cystourethrogram. Of the 13 patients (19.1 per cent) with an abnormal excretory urogram 12 (92.3 per cent) had an abnormal voiding cystourethrogram. Reflux occurred in 16.2 per cent of patients; 6 of 7 patients with grade II reflux and 1 of 3 patients with grade III reflux had a normal excretory urogram.