Long-term benefits of early neurosurgery for lipomyelomeningocele.
OBJECTIVE
Our previous experience with early neurosurgery for lipomyelomeningocele revealed that patients undergoing repair before age 1.5 years were more likely to have normal bladder function. We evaluate the durability of the urological benefits in patients with lipomyelomeningocele with longer followup.


METHODS
A retrospective chart review was performed on all patients who underwent urodynamic testing before and after primary neurosurgical repair of lipomyelomeningocele. A total of 43 patients presented between 1983 and 1995 with at least 12 months of followup (median 68, range 15 to 167).


RESULTS
Of the 43 patients 36 (84%) maintained stable clinical and urodynamic function, and 7 (16%) had late deterioration, which occurred between 9 months and 8 years postoperatively. Of 19 patients with normal urodynamic studies preoperatively 14 (74%) maintained normal function. Overall, 14 of 43 patients (33%) with lipomyelomeningocele had normal bladder and sphincter function during followup. The principal predictor of long-term normal bladder function was preoperative urodynamic status, since urodynamic studies were preoperatively normal in 13 of 14 patients (93%) who maintained normal bladder and sphincter function. Late neurosurgery was equally efficacious if urodynamic studies were normal.


CONCLUSIONS
Our data continue to support early diagnosis and neurosurgical intervention in patients with lipomyelomeningocele, since there is a higher likelihood of normal preoperative function that can be preserved. Furthermore, the results are durable in 84% of cases. However, close followup is necessary, since deterioration can occur up to 8 years postoperatively.
Department of Urology, University of California School of Medicine, San Francisco, USA.
H Y
HY
Wu
B A
BA
Kogan
L S
LS
Baskin
M S
MS
Edwards
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D016013:Likelihood Functions; D008067:Lipoma / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008591:Meningomyelocele / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics