Meningomylocele: An update.
Therapy-resistant overactivity of detrusor or small capacity and poor compliance, will usually need to be treated by bladder augmentation. Ileal or colonic patches are used frequently for augmenting the bladder, with either intestinal segment appearing to be equally useful. Stomach is rarely used because of the associated complications, but it is the only available intestinal segment for patients with impaired renal function. Concerns regarding long-term effects of associated metabolic acidosis, including abnormalities in linear growth and bone metabolism are misplaced. Ureterocystoplasty offers an attractive urothelium-preserving alternative, avoiding the metabolic complications, mucus production and cancer risk of heterotopic epithelium associated with enterocystoplasty. Though ideal for patients with dilated ureter and nonfunctioning kidney, in patients with functioning kidney it carries added risks associated with transuretero-ureterostomy, mainly obstruction. Ureteral dilatation in meningomyelocele patients is avoidable with proper follow-up and treatment. Therefore they rarely should be candidates for this operation. Alternative urothelium-preserving techniques, such as auto augmentation and seromuscular cystoplasty, have not proven to be as successful as standard augmentation with intestinal segment. Work is in progress on various bioengineering techniques to culture and combine bladder cells in tissue culture for regeneration. Early efforts are exciting, but preliminary.
Kapoor
R
R
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow - 226 014, UP, India.
Agrawal
S
S
J Urol. 2002 Feb;167(2 Pt 2):1049-53; discussion 1054
11905876
J Urol. 1981 Aug;126(2):205-9
7196460
J Urol. 1999 Sep;162(3 Pt 2):1068-71
10458433
Br J Urol. 1996 Oct;78(4):596-601
8944517
Curr Urol Rep. 2002 Oct;3(5):382-7
12354347
J Urol. 1986 Jan;135(1):90-3
3941475
MMWR Morb Mortal Wkly Rep. 1991 Aug 2;40(30):513-6
2072886
Scand J Urol Nephrol. 1982;16(3):211-5
7163785
J Urol. 1992 Aug;148(2 Pt 2):588-91
1640528
JAMA. 1984 Sep 21;252(11):1438-42
6206249
J Urol. 1992 Feb;147(2):444-6
1732614
J Urol. 2001 Feb;165(2):564-7
11176436
J Urol. 1997 Jun;157(6):2270-7
9146651
BMJ. 1989 Apr 1;298(6677):856-9
2497823
J Urol. 1993 Sep;150(3):944-7
8345615
JAMA. 1987 Sep 25;258(12):1630-3
3625970
Br J Urol. 1970 Apr;42(2):152-7
5420153
J Urol. 1993 Dec;150(6):1879-83
8230524
BMJ. 1989 Apr 1;298(6677):853-5
2497822
Eur Urol. 2003 Aug;44(2):165-74
12875934
J Urol. 1997 Jun;157(6):2295-7
9146656
J Pediatr Surg. 1987 Jun;22(6):556-8
3302200
Pediatr Neurosci. 1989;15(1):1-12
2699756
N Engl J Med. 1991 Mar 7;324(10):662-6
1994249
J Pediatr. 1998 Apr;132(4):704-8
9580774
Dev Med Child Neurol. 1987 Feb;29(1):91-5
3556803
Pediatrics. 1985 Jan;75(1):58-64
2578222
Urol Clin North Am. 1991 Nov;18(4):649-57
1949398
Neurosurgery. 2002 May;50(5):989-93; discussion 993-5
11950401
J Urol. 1998 Mar;159(3):998-1005
9474216
Pediatrics. 2001 Jul;108(1):E7
11433086
Pediatrics. 1999 Aug;104(2 Pt 1):325-7
10429019
Urol Clin North Am. 2004 Aug;31(3):427-34, viii
15313052
J Urol. 2003 Jan;169(1):305-8
12478177
Am J Obstet Gynecol. 1988 May;158(5):1092-9
2453116
World J Urol. 2004 Sep;22(3):196-9
15368072
J Urol. 1995 Oct;154(4):1500-4
7658577