RESUMO
To review the uronephrological outcomes of myelomeningocele [MMC] patients attending a Spina Bifida Clinic. We retrospectively reviewed the medical records of all patients from the combined Spina Bifida Clinic, at King Khalid University Hospital, Riyadh, Saudi Arabia between 1999 and 2009 who had at least one year of follow-up with us. We examined their demographic data, uronephrological status at presentation, most recent follow-up, and the rate of surgical intervention. During the 10-year period, 188 patients were actively followed-up. The mean age at presentation was 5.3 years +/- 3.6 SD. At their last follow-up, 109 patients [58%] were using clean intermittent catheterization, 44[23%] had received BotoxR injections, and 26 [14%] had undergone bladder reconstruction. Most [66%] patients were older than 3 years when they presented to us; this group had a significantly higher rate of surgical intervention [BotoxR or reconstruction] compared with those who came to us earlier [p=0.003 for patients receiving BotoxR injections, and p=0.025 for patients undergoing bladder reconstruction].Our multidisciplinary Spina Bifida Clinic is an integral part of MCC management to reach a safe urological outcome. Early presentations to our clinic resulted in a lesser need for surgical intercession compared with those who presented at more than 3 years old.
RESUMO
A spontaneous bladder rupture in an intact bladder without history of trauma has been reported before with different postulation for the pathogenesis. All these cases were reported in the adult age group. Patients with a neuropathic bladder associated with such a complication were post augmentation cystoplasty or catheter induced injury. We present our experience in a boy with a neuropathic bladder secondary to spina bifida who had a spontaneous bladder rupture with no surgical intervention carried out before, and discuss the possible pathogenesis