title: Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele.
abstract: OBJECTIVE
  To investigate whether upper urinary tract function and the need for surgery in patients with myelomeningocele depends on the timing of initiating neurourological management.
  
  
  METHODS
  One hundred thirty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on age at the initial evaluation into three categories: from day of birth to age 2 (group 1, n = 67), from age 3 to age 10 (group 2, n = 44), and after age 10 (group 3, n = 22). Upper urinary tract function and the need for surgery with the intention to preserve or normalize the upper urinary tract function were compared between the three groups.
  
  
  RESULTS
  Mean follow-up was 11, 10, and 9 years in group 1, 2, and 3, respectively. The upper urinary tract function was normal in 91%, 80%, and 82% at the initial evaluation (P = 0.194) and in 99%, 86%, and 86% at the last follow-up (P = 0.012) in group 1, 2, and 3, respectively. Following failure of conservative therapy only, the proportions of patients undergoing surgical interventions with the intention to preserve or normalize the upper urinary tract function was significantly (P = 0.0002) different among the three groups: 15%, 34%, and 59%, respectively.
  
  
  CONCLUSIONS
  Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele in the long-term. Therefore, initiation of proactive neurourological management as early as possible, ideally from the day of birth, is strongly recommended.
authors.affiliation: Neuro-Urology Unit, Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Jakob
authors.initials: J
authors.lastname: Lackner
authors.forename: Gustav
authors.initials: G
authors.lastname: Kiss
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.forename: Helmut
authors.initials: H
authors.lastname: Madersbacher
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014553:Urinary Tract Physiological Phenomena; D014570:Urologic Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy*