Upper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management.
To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively. Detrusor leak point pressure (DLPP) over 40 cm H(2)O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) <or= 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP >or= 40 cm H(2)O and decrease in FBC <or= 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.
Bruschini
Homero
H
Division of Urology, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil. bruschini@uol.com.br
Almeida
Fernando G
FG
Srougi
Miguel
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000209:etiology*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000209:etiology