Urinary continence in open myelomeningocele.

Abstract

In a consecutive series of 200 neonates having undergone surgery for open myelomeningocele, 24 of the 106 survivors at 10 to 12 years of age proved to be continent of urine. These figures included 11 children who had considerable neurological involvement. 4 children did not acquire urinary control until after the age of 5 years. Therefore, we consider early urinary diversion in children with myelomeningocele, even in the presence of neurological deficit, to be indicated only for the prevention of progressive deterioration in renal function. Incontinence of urine itself is not an indication for urinary diversion in the first decade of life.

Outcome of Augmentation Cystoplasty and Bladder Substitution in a Pediatric Age Group

“…Accordingly, only 1 out of 21 patients suff ered a decrease of renal function postoperatively in the reported series. The rate of spontaneous urinary continence in children with meningomyelocele is described to be as low as 6 -22 % [16,17] . Social urinary continence can be accomplished by CIC and anticholinergics in 75 -80 % of patients with neurogenic bladder dysfunction [18] .…”

Urinary Continence in Children with Neurogenic Bladders

“…If this fails to achieve the desired results, then at about 6 to 7 years of age one has to resort to a penile collecting device in males and possibly an indwelling catheter for females, in the hope that they are temporary measures only. Brereton et al (1977) have found these to be satisfactory methods and they can certainly be used until the child is old enough for the next step.…”

Urinary Catheters in Spina Bifida

“…Initially, most ehildren were treated by intermittent eatheterisation, but when the desired efTect was not obtained, an indwelling catheter was recommended. The techniques of catheterisation will not be discussed, since they have been adequately described by other authors (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

“…Some older boys with dribbling incontinence can cope with a penile appliance, but otherwise, a problem arises if renal deterioration occurs early in life, or once the child reaches the age when life in a nappy is no longer acceptable (2). In most children in these circumstances, the choice is between urinary diversion and improved bladder drainage, and in view of the poor long-term results of diversion (3-5t there has been arecent revival of interest in catheterisation to improve bladder drainage (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). We have reviewed our cxperience of catheterised children in an attempt to asscss whether or not this method of management is as successful as claimed by other authors, and to discover whether or not there are undesirable side effects or contra-indications.…”