AIMS: To evaluate urodynamic parameters in myelomeningocele patients with native bladders and after augmentation, continence rates and check the longevity of these parameters after lower urinary tract (LUT) reconstruction.
METHODS: A retrospective review of adult myelomeningocele patients with UDS.
RESULTS: 118 adult patients with NGB secondary to myelomeningocele were identified. 58/118 (49.1%) had UDS performed in our clinic: 18/58 (31%) after prior reconstruction ("Augment" group) and 40/58 (69%) during annual urologic follow up ("NoSx" group). Urodyanmic findings after augmentation included: Pdet@MCC 31.1 (1-95) cmH2 O, MCC 495.9 ml, NDO in 3/18 (16.7%), mean DLPP 54.0 (48-60) cmH(2) O and mean ALPP 39.6 (20-110) cmH2 O in 5/18 with an incompetent sphincter. Patients in "NoSx" group had the following findings: Pdet@MCC of 39.6 (1-60) cmH(2) O, MCC 407.5 ml, 18/40 (45%) had NDO, mean DLPP of 48.1 (15-95) cmH2O and mean ALPP = 51 (17-78) cmH2O in 10/40 with incompetent sphincter. In the "NoSx" group, 19/40 (47.5%) had normal bladder compliance. Mean time from the surgery to UDS was 10.4 years. Continent patients in the "NoSx" group had a significantly higher MCC than incontinent patients in the same group (475 vs. 352 ml, P = 0.029). 8/17 (47.1%) continent patients in "NoSx" group had normal UDS.
CONCLUSIONS: Most patients after augmentation maintain low bladder pressures for more than 10 years. Close long-term follow up should be maintained, especially in those patients that have not had prior augmentation. Urinary incontinence may be secondary to poor sphincteric function in patients with and without prior augmentation. Moreover, we should continue to follow patients after reconstruction as elevated detrusor pressures can still be seen. Strict follow up after LUT reconstruction still continues to be important.
Written by:
Vainrib M, Reyblat P, Ginsberg DA. Are you the author?
University of Southern California, Los Angeles, California; Rancho Los Amigos Rehabilitation Center, Downey, California.
Reference: Neurourol Urodyn. 2012 Sep 10. Epub ahead of print.
doi: 10.1002/nau.22304
PubMed Abstract
PMID: 22965686
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