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Urodynamic correlates of resolution of reflux in meningomyelocele patients
S K Agarwal1, G A McLorie, D Grewal
1Department of Surgery, Hospital for Sick Children, Toronto, Canada.
Insights
Resolution of vesicoureteral reflux in pediatric meningomyelocele patients significantly improves bladder storage capacity and compliance. These positive changes in bladder function were confirmed through sequential urodynamic studies, indicating better outcomes.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
Background:
- Meningomyelocele often leads to neurogenic bladder dysfunction, including vesicoureteral reflux.
- Vesicoureteral reflux in these patients can indicate compromised bladder storage.
- Effective management aims to improve bladder storage and prevent renal damage.
Purpose of the Study:
- To correlate the resolution of vesicoureteral reflux with objective changes in bladder storage parameters.
- To evaluate the impact of reflux resolution on urodynamic findings in children with meningomyelocele.
Main Methods:
- A cohort of 27 children with meningomyelocele and vesicoureteral reflux was followed for 10 years.
- Treatment involved clean intermittent catheterization and pharmacotherapy.
- Sequential urodynamic studies were conducted before and after reflux resolution to assess bladder capacity, pressure-specific bladder volume, compliance, and leak point pressure.
Main Results:
- Significant improvements were observed in bladder capacity, pressure-specific bladder volume, and bladder compliance post-reflux resolution.
- A trend towards decreased leak point pressure was noted after the resolution of vesicoureteral reflux.
Conclusions:
- Resolution of vesicoureteral reflux in meningomyelocele patients is associated with significant improvements in bladder storage function.
- Sequential urodynamic studies provide valuable data for monitoring bladder changes and treatment efficacy in this population.
Purpose:
Resolution of reflux in meningomyelocele patients is a reflection of improved bladder storage. We correlated resolution of reflux with changes observed in sequential urodynamic studies.
Materials And Methods:
The study included 27 children with meningomyelocele born between 1975 and 1985 who presented with or developed vesicoureteral reflux. Resolution of reflux was observed during the 10-year followup period as they were treated with a regimen of clean intermittent catheterization and pharmaco-therapy. Urodynamic studies were performed when vesicoureteral reflux was present and subsequent to its resolution. The urodynamic parameters compared in the 2 studies included bladder capacity, pressure specific bladder volume, bladder compliance and leak point pressure.
Results:
Significant increases in bladder capacity, pressure specific bladder volume and bladder compliance were noted. Leak point pressure appeared to be decreased subsequent to resolution of reflux.
Conclusions:
Resolution of reflux in meningomyelocele patients correlates with changes in parameters of bladder storage observed on sequential urodynamic studies.