title: Initial urological evaluation and management of children with neurogenic bladder due to myelomeningocele.
abstract: BACKGROUND
  The proactive management of children with myelomeningocele (MMC) has contributed to decreasing their progression to end-stage renal disease, thanks to early urological evaluation and timing implementation of treatments.
  
  
  OBJECTIVE
  To demonstrate that early urological evaluation of the urinary tract in MMC shows functional alterations in most cases, and that it requires medical intervention, even when in some cases the complementary imaging studies do not show any abnormalities.
  
  
  METHODS
  A retrospective study including 60 patients aged <1 year with MMC who were followed by a multidisciplinary team. All of them underwent renal/bladder ultrasound, videourodynamic studies, renal scintigraphy/dimercaptosuccinic acid (DMSA), and laboratory tests for kidney function. The studied variables were: bladder capacity and pressure, presence of overactivity, vesicoureteral reflux (VUR), urinary dilations and abnormalities on renal scintigraphy/DMSA. All the patients received clean intermittent catheterization (CIC).
  
  
  RESULTS
  See Summary Table all the patients showed alterations in at least some of the assessed urodynamic variables: reduced cystometric capacity, 21.6%; detrusor overactivity, 55%; end filling detrusor pressure >20 cm H2O, 43.3%; inefficient bladder voiding, 98.3%; indirect dyssynergic patterns, 28.8%. The high-risk videourodynamic findings were observed in 28 cases (46.6%). DMSA was abnormal in 30%. Renal impairment was detected in 6.6% of cases. A total of 66% of cases received oxybutynin.
  
  
  CONCLUSIONS
  Almost all the children in this sample population showed urinary dysfunction, and approximately half of them had high-risk videourodynamic findings. Although many cases showed reflex urinary contractions, almost the entire sample had inefficient bladder voiding. An important limitation of this work was the lack of simultaneity in obtaining each of the requested studies.
  
  
  CONCLUSIONS
  In the initial urological evaluation of patients with myelomeningocele, almost all the urodynamic studies showed abnormalities and one-third showed abnormal DMSA, which led to therapeutic actions being initiated, although imaging studies were normal in a great number of patients. CIC alone, starting immediately after birth, is not sufficient. To eliminate or decrease upper tract damage, oxybutynin should be started in addition.
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. Electronic address: cristian.sager@gmail.com.
authors.forename: Cristian
authors.initials: C
authors.lastname: Sager
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Carol
authors.initials: C
authors.lastname: Burek
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Corbetta
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Weller
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Perea
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Enrique
authors.initials: E
authors.lastname: Lago
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Yesica
authors.initials: Y
authors.lastname: Gomez
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Victor
authors.initials: V
authors.lastname: Durán
authors.affiliation: Urology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: López
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D014563:Urodynamics
keywords: Children; Myelomeningocele; Neurogenic bladder; Videourodynamics