Urological outcome after myelomeningocele: 20 years of follow-up.
OBJECTIVE
• To evaluate the urological outcome in a long-term follow-up of individuals with myelomeningocele and relate the findings obtained to urodynamic variables in childhood.


METHODS
• Individuals with myelomeningocele born from 1964-1988 were included at time of urodynamic investigation. • Age at inclusion was in the range from 1 month to 19.5 years (median, 6 years). • Detrusor function was classified as overactive, underactive or non-contractile. • Urethral function was classified according to the leak point pressure. • In childhood and at follow-up, kidney function was estimated with renography and isotope-glomerular filtration rate examinations.


RESULTS
• In total, 52 individuals (28 boys and 24 girls) aged 19-41 years (median, 29 years) had follow-up. • Of these, 37 (71%) individuals had bilateral normal kidney function at follow-up; seven (14%) had normal total renal function but unilateral deteriorated kidney, and eight individuals (15%) had deteriorated kidney function. • Adult individuals with bilateral kidney deterioration had a significant higher frequency of diagnosed detrusor overactivity at childhood urodynamics (63%) compared to those with normal function of both kidneys (24%). In total, 48% of the 52 myelomeningocele individuals were continent at follow-up. • Continence surgery was performed in eight patients, nine used anticholinergica, three had regular botulinum toxin detrusor injections, and 27 used clean intermittent catheterization.


CONCLUSIONS
• Overall, 15% of patients had impairment of kidney function and 48% were urinary continent. • Considering the present age distribution of the present study population, this figure appears to be comparable to the data in the literature. • Urodynamic findings in childhood were predictive for later kidney deterioration.
Thorup
Jorgen
J
Department of Pediatric Surgery and Clinic for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark. j-thorup@rh.dk
Biering-Sorensen
Fin
F
Cortes
Dina
D
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014555:Urination Disorders / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult