The Change of Bladder Function after Neurosurgery in Patients with Lipomyelomeningocele / 대한비뇨기과학회지

ABSTRACT

PURPOSE: To prevent further neurological deterioration by tethering of the spinal cord, an early surgical procedure for asymptomatic lipomyelomeningocele (LMMC) can be performed. The neurogenic bladder patterns, degree of improvement according to timing of surgery, and the relationship between the change in the upper urinary tract and neurogenic bladder pattern were evaluated. MATERIALS AND METHODS: A retrospective chart review was performed on all 39 patients, before and after primary neurosurgical repair of LMMC, who presented between 1996 and 2003. RESULTS: Preoperative urodynamics (UDS) revealed a neurogenic bladder in 23 patients (59%). Of these 23 patients, 16 had a hyperreflexic and 7 an areflexic bladder. Of the 16 who had a hyperreflexic bladder, 4 and 2 were changed to normal and areflexic bladders, respectively, but 10 remained unchanged postoperatively. In 3 patients repeated UDS was performed, with 1 remaining unchanged, but 2 changed to an areflexic bladder. Of the 7 patients with an areflexic bladder, 1 changed to a hyperreflexic bladder, but 6 remained unchanged postoperatively. All 3 patients who underwent a repeated UDS remained unchanged. Hydronephrosis was noted on ultrasonography in 3 patients. The degree of improvement according to the timing of surgery was not statistically significant. All 16 patients who had a normal bladder remained unchanged postoperatively, and 2 patients who underwent repeated UDS changed to a hyperreflexic bladder. CONCLUSIONS: Even when pre- and postoperative UDS reveal a normal bladder function, long-term follow-up through UDS is still required. The use of routine preoperative and periodic postoperative urodynamic evaluations is important in children with LMMC, but without clinically overt symptoms.