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Title: Lower urinary tract dysfunction in children with myelomeningocele. Diagnostic and therapeutic procedure

Danuta Leśniak, Andrzej Chilarski
Pediatric Review
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myelomeningocele, neurogenic bladder, diagnostic examinations, pharmacology, urological procedures, urodynamic examination

Introduction. The rate of dysraphic diseases is estimated at 0.7-0.8 per 1000 newborns in the world and at 2.05-2.68 per 1000 born in Poland. One of the most serious disturbances caused by Myelomeningocele is neurogenic urinary tract dysfunction. Objectives. Retrospective analysis was conducted among children with MMC in order to evaluate the urinary tract and to define treatment and diagnostic procedure for dysraphic children. Material and methods. The paper presents an analysis of 245 children with myelomeningocele who were treated in the Dysraphic Defects Outpatients Clinic from 1994 to 2002. Whole group was subdivided into three smaller groups according to the time they came to the clinic. The following examinations are discussed: USG, cystography, urodynamic examination as well as the influence of the treatment on urine continence. The dynamic character of neurogenic dysfunction and necessity to diagnose and treatment of it as early as possible was emphasized. Results. Reflux was the most frequent in 2nd group (for children who entered the Clinic at the age of 4-12 months, examination was done in the 10 month on average). The most common type of changes stated in the urodynamic examinations was overactive bladder with dyssynergia (44.8%). This kind of change was the most common also among children with reflux as well. Upper urinary tract was assessed by ultrasound and in certain cases by radionuclid scan or Intra Venous Pyelography examination. The treatment included: CIC, anticholinergic and antibacteriological medicaments depending on the changes observed. In all groups urine continence was improved. If medical treatment wasn't successful children were qualified to surgical procedure (most common in 3 rd group). Conclusions. The neurogenic urinary tract dysfunction is a dynamic distortion and it is recommended to diagnose and treat it is as early as possible.