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Development of the urodynamic pattern in infants with myelomeningocele
U Sillén1, E Hansson, G Hermansson
1Department of Pediatric Surgery, Children's Hospital, Göteborg University, Sweden.
Insights
Urodynamic patterns in infants with myelomeningocele (MMC) change significantly in the first year, particularly between 1-4 months. These changes correlate with upper urinary tract issues like reflux.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Developmental Pediatrics
Background:
- Myelomeningocele (MMC) often leads to neurogenic bladder dysfunction.
- Understanding early urodynamic changes is crucial for preventing upper urinary tract damage.
Purpose of the Study:
- To investigate urodynamic pattern evolution in infants with MMC during their first year.
- To correlate these urodynamic changes with adverse effects on the upper urinary tract.
Main Methods:
- Prospective study of 34 infants with MMC.
- Urodynamic assessments (cystometry, micturating cystourethrography, urography) at 1, 4, and 10 months of age.
Main Results:
- Increased detrusor activity observed, with hyper-reflexia rising from 45% to 65% by 4 months.
- Poorly compliant bladders and elevated outlet resistance increased during the first year.
- Vesico-ureteric reflux occurred in 12 patients, strongly correlating with poor compliance, hypercontractility, and outlet obstruction.
Conclusions:
- Significant changes in detrusor activity and outlet resistance occur in infants with MMC within the first year.
- These urodynamic alterations, especially between 1-4 months, are linked to upper urinary tract deterioration.
- Early detection and management of these changes are vital for preserving renal function.
Objective:
To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract.
Patients:
methods Thirty-four infants with MMC were investigated using cystometry, micturating cystourethrography and urography at 1, 4 and 10 months of age.
Results:
Detrusor contractility was characterized by an increase in activity, with hyper-reflexia in 45% initially, increasing to 65% at the 4-month investigation. During the same period, the number of infants with areflexia decreased from 25% to 12%. Between 4 and 10 months, there were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the first and fourth month. The number of patients with elevated outlet resistance increased only slightly during the first year, from 32% of all infants at the initial investigation to 40% at the 10-month follow-up. Vesico-ureteric reflux was detected in 12 of the patients during the year, with five already diagnosed at the first investigation. Almost all refluxes were cured with clean intermittent catheterization, with additional pharmacological therapy in two patients; one patient required a vesicostomy.
Conclusions:
This study indicates that detrusor activity, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in activity and occurred mostly between the first and fourth months of age. There was a strong correlation between the occurrence of reflux and poor compliance, hypercontractility and outlet obstruction.