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Decreased bladder compliance in patients with myelomeningocele treated with radiological observation
A M Kaufman1, M L Ritchey, A C Roberts
1Department of Surgery, University of Texas-Houston Medical School, USA.
Insights
Frequent imaging for children with spina bifida and neurogenic bladder detects upper tract issues, but doesn't always improve bladder compliance or continence. Urodynamic assessment is crucial for optimal management.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Spina Bifida Care
Background:
- Advocacy for frequent radiological surveillance in children with neurogenic bladder secondary to spina bifida.
- Concerns regarding the impact of expectant management on bladder compliance and urinary continence.
Purpose of the Study:
- To review the consequences of radiological surveillance on bladder compliance and continence in children with neurogenic bladder due to spina bifida.
- To evaluate the effectiveness of expectant management strategies.
Main Methods:
- Retrospective review of 214 children with spina bifida over 13 years.
- Regular imaging studies (6-12 month intervals) and urodynamics when indicated.
- Analysis of outcomes following clean intermittent catheterization and pharmacological therapy.
Main Results:
- Upper urinary tract deterioration observed in 79 children (38%), including hydronephrosis and vesicoureteral reflux.
- Improvement in upper tract changes in 69% after treatment, but bladder compliance improved in only 42%.
- Surgical intervention (enterocystoplasty) was required in 34 children.
Conclusions:
- Radiological surveillance identifies upper tract changes in myelomeningocele patients.
- Elevated outlet resistance effects on bladder compliance are less reversible than radiographic findings.
- Urodynamic findings should guide treatment to potentially reduce the need for enterocystoplasty.
Purpose:
Recently others advocated frequent radiological surveillance to detect upper urinary tract deterioration in children with neurogenic bladder secondary to spina bifida. We reviewed the consequences of such expectant management on bladder compliance and urinary continence.
Materials And Methods:
We retrospectively reviewed the records of 214 children presenting to our spina bifida clinic in a 13-year period. Follow-up is available for 95 girls and 86 boys. Imaging studies of the kidneys were repeated at 6 to 12-month intervals. Urodynamics were performed when upper urinary tracts deteriorated or in incontinent school age children.
Results:
On radiographic study there was evidence of upper urinary tract deterioration in 79 children, including hydronephrosis in 34, hydronephrosis and vesicoureteral reflux in 19, and reflux only in 26. Follow up studies performed after clean intermittent catheterization and pharmacological therapy were instituted revealed resolution or improvement of upper tract deterioration in 52 patients (69%), while bladder compliance improved in only 42%. Surgical intervention was required in 34 children, despite improvement of upper tract changes in many of these patients on follow up radiographic studies.
Conclusions:
Although radiological surveillance of patients with myelomeningocele allows recognition of upper tract changes, the effects of elevated outlet resistance on bladder compliance are not as readily reversible as the initial radiographic findings. The incidence of enterocystoplasty exceeds that reported for patients treated prospectively based on urodynamic findings, which should be considered in the treatment of these children.