Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele

R. D. Hernandez, R. S. Hurwitz, J. E. Foote, P. E. Zimmern, G. E. Leach, S. P. Greenfield

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

The 2 major urological objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. We report our success in managing these cases with nonsurgical therapy. From 1981 to 1991, 45 patients with myelomeningocele 1 to 15 years old were evaluated urodynamically before and after initiating nonsurgical treatment. Pretreatment urodynamics identified 2 groups. Group 1 consisted of 31 patients with leak point pressure of 40 cm. water or more of whom 10 had grades II to V/V vesicoureteral reflux and 4 had moderate or severe hydronephrosis. Group 2 consisted of 14 incontinent patients with leak point pressure of less than 40 cm. water and no reflux or hydronephrosis. Both groups were treated with intermittent catheterization, anticholinergic medications and fluid restriction. Within a mean followup of 5.5 years nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm. water in 22 of 31 group 1 patients (71%), and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patients. Of 4 patients in group 1 with persistent high grade vesicoureteral reflux or severe hydronephrosis 3 (10%) required augmentation cystoplasty. With nonsurgical management 18 patients (40%) were completely continent, 18 (40%) required 2 or less pads daily and 9 (20%) required more than 2 pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory with nonsurgical management.

Original languageEnglish (US)
Pages (from-to)1582-1585
Number of pages4
JournalJournal of Urology
Volume152
Issue number5 I
StatePublished - 1994

Fingerprint

Meningomyelocele
Urinary Incontinence
Urinary Tract
Hydronephrosis
Vesico-Ureteral Reflux
Pressure
Water
Urodynamics
Cholinergic Antagonists
Catheterization
Kidney

Keywords

  • hydronephrosis
  • meningomyelocele
  • urinary incontinence
  • urinary tract
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

Hernandez, R. D., Hurwitz, R. S., Foote, J. E., Zimmern, P. E., Leach, G. E., & Greenfield, S. P. (1994). Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele. Journal of Urology, 152(5 I), 1582-1585.

Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele. / Hernandez, R. D.; Hurwitz, R. S.; Foote, J. E.; Zimmern, P. E.; Leach, G. E.; Greenfield, S. P.

In: Journal of Urology, Vol. 152, No. 5 I, 1994, p. 1582-1585.

Research output: Contribution to journalArticle

Hernandez, RD, Hurwitz, RS, Foote, JE, Zimmern, PE, Leach, GE & Greenfield, SP 1994, 'Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele', Journal of Urology, vol. 152, no. 5 I, pp. 1582-1585.
Hernandez, R. D. ; Hurwitz, R. S. ; Foote, J. E. ; Zimmern, P. E. ; Leach, G. E. ; Greenfield, S. P. / Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele. In: Journal of Urology. 1994 ; Vol. 152, No. 5 I. pp. 1582-1585.
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