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European Journal of Pediatrics

, Volume 160, Issue 7, pp 414–420 | Cite as

Bladder-sphincter dysfunction in myelomeningocele

  • Jan D. van Gool
  • Pieter Dik
  • Tom P. V. M. de Jong
REVIEW

Abstract

 Pediatric urodynamics taught us that detrusor-sphincter dyssynergia creates a bladder outlet obstruction in about 50% of any population of children with myelomeningocele. This functional obstruction causes renal damage due to obstructive uropathy, exactly the same way as a congenital anatomical urethral obstruction does. Pediatric urodynamics also taught us that in children with myelomeningocele pelvic floor activity and detrusor activity can be abnormal (hyperactive or inactive) completely independent from each other. These insights have changed the management of myelomeningocele. Children with overactivity of the pelvic floor can be singled out at infant age, and started on clean intermittent catherization, to prevent obstructive uropathy and preserve renal function. Children with detrusor overactivity can be singled out too at very early age, and treated with anticholinergics, to prevent irreversible structural damage to the detrusor and preserve normal bladder capacity and compliance.

Key words Myelomeningocele Neuropathic bladder-sphincter dysfunction Detrusor-sphincter dyssynergia Clean intermittent catheterization Anticholinergics Bladder compliance Bladder capacity Obstructive uropathy Urodynamics 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • Jan D. van Gool
    • 1
  • Pieter Dik
    • 1
  • Tom P. V. M. de Jong
    • 1
  1. 1.Paediatric Renal Centre WKZ, `Wilhelmina Kinderziekenhuis', University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands e-mail: jd.vangool@attglobal.netNL

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