Urodynamic evaluation in children with lipomeningocele: timing for neurosurgery, spinal cord tethering and followup.
OBJECTIVE
We assessed the usefulness of urodynamic testing for determining the optimal timing of surgery and for evaluating the development of bladder function in children with lipomeningocele.


METHODS
We retrospectively evaluated 64 patients (40 females) 3 to 17 years old (mean 8.5) with lipomeningocele. Patients were divided into 3 groups based on age at surgery, ie younger than 12 months (34 patients), 12 to 36 months (17) and older than 36 months (13). All patients underwent urodynamic testing preoperatively and during extended followup (mean 6.5 years, range 3 to 12).


RESULTS
Bladder capacity and mean detrusor leak pressure improved in all groups but particularly in patients operated on within the first year of life. At the end of the study mean bladder capacity was 420 cc in patients younger than 12 months, 300 cc in those 12 to 36 months old and 260 cc in those older than 36 months (p <0.01), and mean detrusor leak pressure was 37, 54 and 55 cm H(2)O, respectively (p <0.01). At the latest followup 65% of patients in the youngest group had improved urodynamic parameters vs 33% of those 12 to 36 months old and 28% of those older than 36 months.


CONCLUSIONS
Urodynamic evaluation and the presence of neurological impairment have crucial roles in determining the optimal timing of surgery in patients with lipomeningocele, and in diagnosing the onset of tethered cord. Our data show that early surgical repair seems to reduce the risk of neurological deterioration of the lower urinary tract, and allows a more physiological development of urinary function.
Rendeli
C
C
Department of Paediatric Science, Institute of Neurosurgery, Catholic University Medical School, Policlinico A. Gemelli, Largo Gemelli 8, 00168 Rome, Italy. c.rendeli@libero.it
Ausili
E
E
Tabacco
F
F
Focarelli
B
B
Massimi
L
L
Caldarelli
M
M
Tamburrini
G
G
Di Rocco
C
C
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008588:Meningocele / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*