Téma: 

Urological complications in children with myelomeningocele in first year of life

Ladislav Valanský, Zuzana Kurcinová, Eva Sádová, Ľudmila Podracká

Introduction. Myelomeningocele (MMC) leads to neurogenic voiding dysfunction (NVD) in about 90 %, in 55 % is connected with the risk of upper urinary tract (UUT) damage. Aims of study. To assess the frequency of urological complications in children with MMC in the first year of life and point the need of urological investigation at the neonatal period. Methods. 49 girls and 36 boys 3 month old in average underwent clinical examination, bladder and UUT sonography, retrograde cystography, 52 (61 %) also urodynamic investigation to demonstrate the presence of detrusor-sphincter dyssynergy (DSD), values of leak point pressure (LPP) and resting maximum urethral pressure (MUP). These parameters and postvoiding residual volume (PVR) were used for functional classification of NVD. Results. NVD was found in 74 (87 %) children. 46 (54 %) had failure to empty (PVR > 5 ml, LPP > 40 cm H2O), 17 (20 %) failure to store, 11 (13 %) could not be classified. Changes on UUT were found in 28 (33 %) children. 20 (24 %) had hydronehrosis, 19 (95 %) of them had failure to empty, 14 (74 %) of them had DSD. Vesicoureteral reflux (VUR) was found in 15 (18 %) children, 7 of them had DSD. VUR spontaneously disappeared in 4 children and in other its grade decreased. Urodynamic investigation in all cases confirmed primary origin of VUR. Urinary tract infection was found in 32(38 %) children, 25 (78 %) of them had failure to empty. Febrile infection was observed in 7 (8 %) children, in any case with failure to empty with DSD and VUR. The results confirm that MMC may cause serious UUT damage still at the infancy. Therefore, urological investigation should be performed at the neonatal period.

Ročník 2005  Témy časopisu Clinical urology 1 / 2005

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