The chances of a spina bifida patient becoming continent/socially dry by conservative therapy.
One hundred and one patients with neurogenic lower urinary tract dysfunction due to myelomeningocele or sacral dysplasia, all older than 10 years of age, with a mean age of 15 years, and under regular urological control for many years were evaluated to discover if they had achieved urinary continence (dry day and night) or the status of socially dry (with dry intervals of more than 3 hours) with conservative means of treatment; or whether they remained incontinent or required operative procedures. The results were correlated with the urodynamic pattern of their detrusor-sphincter dysfunction and with the methods they used for bladder emptying. Special attention was paid to the effects of the various conservative treatment modalities nowadays available. The chances of becoming continent or at least socially dry by conservative therapy are best for patients with sphincter hyperreflexia provided that (1) the detrusor was already hypo- or areflexic, or detrusor hyperreflexia could be successfully controlled, and (2) that regular bladder emptying was achieved by clean intermittent (self) catheterisation. Twenty-four out of 45 patients in this group fulfilled these criteria: 18 are continent, 6 socially dry, a success rate of 54%. In patients with sphincter weakness the outlook is worse: in combination with detrusor hyperreflexia there is only a 16% chance, and in those with detrusor areflexia a 37% chance of becoming continent or socially dry, with the best results in wheelchair patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Knoll
M
M
Department of Urology, University Hospital, Innsbruck, Austria.
Madersbacher
H
H
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D012018:Reflex / Q000502:physiology; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery / Q000628:therapy*; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery / Q000628:therapy*