World Journal of Urology

, Volume 24, Issue 2, pp 224–228 | Cite as

Upper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management

  • Homero Bruschini
  • Fernando G. Almeida
  • Miguel Srougi
Original Article


To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively.Detrusor leak point pressure (DLPP) over 40 cm H2O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) ≤ 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP ≥ 40cmH2O and decrease in FBC ≤ 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.


Urodynamic Neurogenic bladder Urinary incontinence Myelomeningocele Spinal dysraphism 


  1. 1.
    Bauer S, Labib KB, Dieppa RA, Retik A (1977) Urodynamic evaluation of boy with myelodysplasia and incontinence. Urology 10:354–62PubMedCrossRefGoogle Scholar
  2. 2.
    Bauer SB, Hallet M, Khoshbin S, Lebowitz RL, Winston KR, Gibson S, Colodny AH, Retik AB (1984) Predictive value of urodynamic evaluation in newborns with myelodysplasia. JAMA 252:650–652PubMedCrossRefGoogle Scholar
  3. 3.
    Cass AS, Luxenberg M, Johnson CF, Gleich P (1985) Incidence of urinary tract complications with myelomeningocele. Urology 25:374–378PubMedCrossRefGoogle Scholar
  4. 4.
    Galloway NTM, Mekras JA, Helms M, Webste GD (1991) An objective score to predict upper tract deterioration in myelodysplasia. J Urol 145:535–537PubMedGoogle Scholar
  5. 5.
    Ghoniem GM, Roach MB, Lewis VH, Harmon EP (1990). The value of leak pressure and bladder compliance in the urodynamic evaluation of meningomyelocele patients. J Urol 144:1440–1442PubMedGoogle Scholar
  6. 6.
    Hopps CV, Kropp KA (2003). Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close follow up. J Urol 169(1):305–309PubMedCrossRefGoogle Scholar
  7. 7.
    Kaefer M, Rosen A, Darbey M, Kelly M, Bauer SB (1997) Pressure at residual volume: A useful adjunct to standard fill cystometry. J Urol 158:1268–1270PubMedCrossRefGoogle Scholar
  8. 8.
    Kaefer M, Zurakowski D, Bauer SB, Retik AB, Peters CA, Atala A, Treves ST (1997) Estimating normal bladder capacity in children. J Urol 158:2261–2264PubMedCrossRefGoogle Scholar
  9. 9.
    Landau EH, Churchill BM, Jayanthi VR, Gilmour RF, Steckler RE, McLorie GA, Khoury AE (1994) The sensitivity of pressure specific bladder volume versus total bladder capacity as a measure of bladder storage dysfunction. J Urol 152:1578–1581PubMedGoogle Scholar
  10. 10.
    Lelis MA, Glashan R, Féra P, Truzzi JC, Simonetti R, Srougi M, Bruschini H (2004) The use of urodynamic parameters for improvement of continence in patients under intermittent catheterization. Neurourol Urodyn 23:555–556Google Scholar
  11. 11.
    McGuire EJ, Woodside JR, Borden TA (1983) Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia : A followup study. J Urol 129:823–829PubMedGoogle Scholar
  12. 12.
    McGuire EJ, Woodside JR, Borden TAM, Weiss RM (1981) Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 126:205–209PubMedGoogle Scholar
  13. 13.
    Partington MD, McLone DG (1995) Hereditary factors in the etiology of neural tube defects. Pediatr Neurosurg 23:311–316PubMedCrossRefGoogle Scholar
  14. 14.
    Reiner I, Jones M, Donnel S, Rickwood AMK (1992) Incidence of normal micturition in myelomeningocele patients. Arch Dis Child 67:640–641PubMedCrossRefGoogle Scholar
  15. 15.
    Riccabona M, Koen M, Schindler M, Goedele B, Pycha A, Lusuardi SB (2004) Botulinum-A toxin injection into the detrusor : a safe alternative to the treatment of children with myelomeningocele with detrusor hyperreflexia. J Urol 171(2 pt 1):845–848PubMedCrossRefGoogle Scholar
  16. 16.
    Roach MB, Switters DM, Stone AR (1993) The changing urodynamic pattern in infants with myelomeningocele. J Urol 150:944–947PubMedGoogle Scholar
  17. 17.
    Rosenfeld DR, Chiang H, Crisostomo R, Salgado G (1990) Manejo urologico de 437 pacientes con mielomeningocele. Ver Chil Urol 53:172–175Google Scholar
  18. 18.
    Sidi AA, Dykstra DD, Gonzalez R (1986) The value of urodynamic testing in the management of neonates with myelodysplasia: a prospective study. J Urol 135:90–393PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Homero Bruschini
    • 1
    • 2
  • Fernando G. Almeida
    • 1
  • Miguel Srougi
    • 1
  1. 1.Division of UrologyFederal University of Sao Paulo, Paulista School of MedicineSao PauloBrazil
  2. 2.Sao Paulo,Brazil

Personalised recommendations