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Lower urinary tract function in ambulatory children with spina bifida
R A Mevorach1, G A Bogaert, L S Baskin
1Department of Urology, University of California School of Medicine, San Francisco, USA.
Insights
Ambulatory children with myelomeningocele (MM) exhibit significant lower urinary tract dysfunction. Early diagnosis and treatment are crucial for managing these urological issues, regardless of mobility aids.
Area of Science:
- Pediatric Urology
- Neuroscience
- Developmental Biology
Background:
- Myelomeningocele (MM) is a complex birth defect affecting the spinal cord.
- Lower urinary tract dysfunction (LUTD) is a common complication in children with MM.
- Ambulatory status does not preclude significant urological issues.
Purpose of the Study:
- To evaluate lower urinary tract function in children with MM who can walk.
- To determine if mobility aids influence the spectrum of LUTD.
- To highlight the need for consistent urological care in ambulatory MM patients.
Main Methods:
- Retrospective review of 45 ambulatory children with MM.
- Analysis of clinical and urodynamic data.
- Comparison between independent walkers and those using ankle-foot orthotics.
Main Results:
- Only 3 of 45 children had normal voiding patterns; the rest showed neurogenic LUTD.
- No significant difference in LUTD spectrum between independent walkers and those using orthotics.
- Children with persistent incontinence were diagnosed later than continent children.
Conclusions:
- Ambulatory children with MM experience the full range of LUTD.
- Consistent diagnostic and therapeutic attention is vital for all children with MM, irrespective of ambulatory status.
- Proactive urological management is essential to prevent complications of untreated LUTD.
Objective:
To investigate lower urinary tract function in ambulatory children with myelomeningocele.
Patients And Methods:
The urological course of 45 children with myelomeningocele who walked either independently (19 children) or with ankle-foot orthotics (26 children) was reviewed. Follow-up ranged from 9 months to 13.5 years (mean 4.75 years).
Results:
A normal pattern of voiding was observed both clinically and during urodynamic evaluation in only three of the 45 children, with the remainder displaying neurogenic lower urinary tract dysfunction. The independent walkers and those with orthotics did not differ in the spectrum of lower urinary tract dysfunction or other variables. Those patients with persistent incontinence underwent an initial urodynamic evaluation when older (mean 3.7 years versus 6.4 weeks in those who were continent).
Conclusion:
Ambulatory children with myelomeningocele suffer the full spectrum of lower urinary tract dysfunction. Given the potential danger of untreated lower urinary tract dysfunction, ambulatory children with myelomeningocele should receive the same diagnostic and therapeutic attention as their peers with more overt neurological deficits.