The Changing Neurourologic Lesion in Myelodysplasia

Abstract

Seventy-nine newborns with myelodysplasia were followed up for 1 1/2 to six years with serial roentgenographic, neurologic, and urodynamic evaluations. Twenty-nine infants (37%) demonstrated changes in external urethral sphincter innervation during the first three years of life. Of the group who changed, 896% (25/29 infants) did so in the first year, 10% (3/29 infants) in the second year, and 4% (1/29 infants) in the third. The risk factor for change was 32%, 6%, and 2%, respectively, during each of these three years. Fifteen infants (19% of the total) experienced neurourologic deterioration while 14 infants (18%) improved. Seven newborns underwent a second neurosurgical procedure resulting in improvement in four, stabilization in two, and further deterioration in one. These findings underline the importance of early and continued neurologic and urologic surveillance in children with myelodysplasia because it is a dynamic disease process.

The neurogenic bladder: medical treatment

“…Without proper management, urinary tract infections and elevated bladder pressures with secondary bladder-wall changes may cause upper urinary tract deterioration within 3 years in up to 58% [5]. One third of children who develop impaired kidney drainage do so within the first year of life [19]. The specific abnormalities vary considerably and are not predicted by the level of the spinal cord defect.…”

Leak‐point pressures

“…The use of CISC and anticholinergic medication, in addition to several surgical procedures to enhance the bladder capacity or lower the outlet resistance directly, are common in the management of this group of patients. With the realization that bladder and outlet behaviour cannot be predicted solely from the level of the neurological lesion, the role of urodynamics in assessing the exact degree of voiding dysfunction has become increasingly important [15]. As there is only a poor correlation between symptoms and urodynamic findings it is essential that urodynamics be performed periodically.…”

Management Goals for the Spina Bifida Neurogenic Bladder: A Review from Infancy to Adulthood

“…17 However, in children with spina bifida, neurologic lesions are not always stable and bladder pathologies change. Spindel and colleagues 18 noted that 37% of 79 infants with MMC experienced external sphincter changes during the first 3 years of life, with the greatest number of changes occurring during the first year. Because urodynamic findings frequently change during longitudinal follow-up, serial urodynamic and upper tract evaluations are recommended every 6 months.…”