The Management and Evaluation for the Urological Complications following Meningomyelocele

Yoon, Jung Chul; Moon, Woo Chul; Kim, Si Whang

Abstract

With the advent of improved neurosurgical techniques and ventricular shunt, urological complications advanced to become the major obstacles to health and life quality for individuals with meningomyelocele. Herein, we reviewed 34 patients with neurogenic bladder secondary to meningomyelocele. The most common clinical presentation was urinary incontinence (70.6%). The most common location wag lumbosacral spine (53%). Uroradiological study showed hydronephrosis in 19 patients (55.8%), chronic pyelonephritis in 7 (20.6%), and vesicoureteral reflux in 11 of 26 (42.3%). According to the results of urodynamic study 24 patients were classified as follow , Group 1 ; low compliance and low pressure bladder with storage failure (16.7 %), Group II ;low compliance and high bladder pressure with emptying failure (58.3%), Group III, detrusor external sphincter dyssynergia with emptying failure (12.5 %),Group IV; atonic bladder (12.5%), Group II and III showed high incidence of upper tract dilatation and vesicoureteral reflux which seemed to be caused by high bladder pressure. The Group I and IV showed very low incidence of upper tract dilatation and vesicoureteral reflux. The most commonly applied treatment modality was urinary diversion. Recently 6 patients were treated by intermittent catheterization, which was effective in resolving upper tract dilatation and preventing febrile urinary tract infection. One patient underwent successful bilateral ureteral reimplantation. One patient underwent cutaneous vesicostomy. It seems that we should try to diagnose and treat high pressure group as soon as possible, and apply intermittent catheterization and antireflux surgery more frequently in patients with meningomyelocele.