ABSTRACT
BACKGROUND: The aim of this study was to describe voiding dysfunction and urinary tract complications in a population above 16 years of age with myelomeningocele. MATERIAL AND METHODS: 51 persons were included in the study. Data were obtained by questionnaires, ultrasound and glomerular filtration rate; in those with intact urinary bladder, by cystometry and videocystography. RESULTS: 30 out of 33 persons with intact urinary bladder were incontinent. Those with daily incontinence described this as a major problem. Cystometry concluded with normal detrusor contractions in three, detrusor hyperreflexia in five, and a detrusor hyporeflexia in 25 persons. Three out of 30 had vesicoureteral reflux. Ultrasound showed mild hydronephrosis and/or scarring in three persons. Average glomerular filtration rate was 86% (50-131%). 11 had Bricker diversion and seven continent reservoirs. 15 out of 18 persons with urinary diversion were satisfied with this solution. In persons with urinary diversion, the average glomerular filtration rate was 78% (44-109%). Ultrasound showed hydronephrosis and/or scarring in seven out of 16. Overall, urinary tract infections last year were reported by 56%, and pyelonephritis was more common in those with urinary diversion. INTERPRETATION: Incontinence is a common problem in adults with myelomeningocele. About one third had upper urinary tract changes, but none had renal failure.
Subject(s)
Meningomyelocele/complications , Urinary Incontinence/etiology , Adolescent , Adult , Female , Glomerular Filtration Rate , Humans , Hydronephrosis/diagnostic imaging , Hydronephrosis/etiology , Hydronephrosis/physiopathology , Kidney Diseases/complications , Kidney Diseases/diagnosis , Kidney Diseases/physiopathology , Male , Meningomyelocele/physiopathology , Surveys and Questionnaires , Ultrasonography , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/physiopathology , Urinary Diversion , Urinary Incontinence/diagnosis , Urinary Incontinence/physiopathology , Urinary Incontinence/surgery , Urinary Reservoirs, Continent , Vesico-Ureteral Reflux/diagnosis , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/physiopathologyABSTRACT
BACKGROUND: More than 90% of persons with myelomeningocele have a neurogenic bladder disturbance with incontinence and risk of upper urinary tract deterioration. Both aspects need to be considered when planning treatment and follow-up. MATERIAL AND METHODS: The study is based on review of articles and clinical experience. RESULTS: A thorough examination of the patient's voiding methods and incontinence is necessary. Examinations for renal function, reflux and hydroureteronephrosis as well as cystometry should also be carried out. The results of such examinations, together with an assessment of the patient's motor and cognitive function, as well as motivation, will provide a basis for further treatment and follow-up. We suggest a flow-chart for treatment and follow-up of persons above 16 years of age with myelomeningocele. INTERPRETATION: Patients with myelomeningocele should have a thorough examination and an individual plan for treatment and follow-up of their urinary tract dysfunction. Depending on the pathological findings, routine follow-up should be in done intervals from six months to five years.
Subject(s)
Meningomyelocele/complications , Urinary Incontinence/etiology , Adult , Follow-Up Studies , Humans , Kidney Function Tests , Meningomyelocele/physiopathology , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/physiopathology , Urinary Diversion , Urinary Incontinence/diagnosis , Urinary Incontinence/physiopathology , Urinary Reservoirs, Continent , Urinary Tract Infections/diagnosis , Urinary Tract Infections/etiology , Urinary Tract Infections/physiopathologyABSTRACT
Patients with a recent traumatic spinal cord lesion admitted consecutively to Sunnaas Rehabilitation Hospital during the five-year period from 1987 to 1991 were included in a study of bladder function, including results of urodynamic investigation and urological complications, both during primary rehabilitation and on average five years (two to nine years) after injury. Indication for urodynamic investigation was found in 125 out of 170 patients. The study shows that micturition is a major problem after spinal cord injury, and that the follow-up programme after the rehabilitation period should be improved. General practitioners should be aware of these problems. Close cooperation between the rehabilitation department and the primary health service is needed to avoid renal and urinary complications in these patients.
Subject(s)
Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/etiology , Urinary Bladder/physiopathology , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/rehabilitation , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder, Neurogenic/rehabilitation , UrodynamicsABSTRACT
Patients with neurogenic bladder dysfunction may have an elevated detrusor pressure during the filling or emptying phase, which may result in upper urinary tract dysfunction. Cystometric examination is important in order to evaluate the risk of such complications and the effect of therapeutic intervention. If compliance is low, the cystometric filling rate has to be slow in order to obtain a physiologically representative pressure. In the case of detrusor hyperreflexia, intraindividual variation makes it necessary to perform repeated filling of the bladder in order to get representative values for the amplitude and duration of the detrusor contraction. The clinical significance of these methodological problems is discussed.
