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Related Experiment Videos

Retained sacral function in children with high level myelodysplasia

M A Pontari1, M Keating, M Kelly

  • 1Department of Urology, Boston Children's Hospital, Massachusetts, USA.

The Journal of Urology
|August 1, 1995
PubMed
Summary

Children with myelomeningocele and sacral sparing can maintain bladder function but risk upper urinary tract deterioration over time. Early monitoring is crucial for preserving kidney health in these patients.

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Area of Science:

  • Pediatric Urology
  • Neurogenic Bladder
  • Spinal Cord Injury

Background:

  • Myelomeningocele often results in impaired sacral nerve function affecting bladder control.
  • Assessing sacral function is critical for predicting potential complications in affected children.

Purpose of the Study:

  • To evaluate the preservation of sacral function in children with myelomeningocele and spinal cord lesions above L3.
  • To determine the risk of upper urinary tract deterioration in relation to sacral sparing.

Main Methods:

  • Retrospective analysis of 151 myelomeningocele patients undergoing urodynamic evaluation (1980-1992).
  • Neurological examination to assess lesion level and sacral sparing (external sphincter potentials, reflexic bladder activity).
  • Radiological studies to identify upper urinary tract deterioration (reflux, hydronephrosis).

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Main Results:

  • 54% of patients exhibited sacral sparing, with 70% of these showing detrusor-sphincter dyssynergia.
  • Upper urinary tract deterioration was observed in 18% of younger children (<1 year) with sacral sparing, increasing to 57% after age 1.
  • Children without sacral sparing showed deterioration in 28% of cases studied after age 1.

Conclusions:

  • Sacral function can be preserved in myelomeningocele patients with higher spinal cord lesions.
  • Preserved sacral function, even with flaccid lower extremities, poses a risk for upper urinary tract deterioration.
  • This risk significantly increases with time, highlighting the need for vigilant monitoring and timely intervention.