Urological outcome after myelomeningocele: 20 years of follow-up

Study Type - Therapy (case series)¿Level of Evidence 4 OBJECTIVES: To evaluate the urological outcome in a long-term follow-up of individuals with myelomeningocele and relate the findings obtained to urodynamic variables in childhood. MATERIAL AND METHODS: Individuals with myelomeningocele born from 1964-1988 were included at time of urodynamic investigation. Age at inclusion was in the range from 1 month to 19.5 years (median, 6 years). Detrusor function was classified as overactive, underactive or non-contractile. Urethral function was classified according to the leak point pressure. In childhood and at follow-up, kidney function was estimated with renography and isotope-glomerular filtration rate examinations. RESULTS: In total, 52 individuals (28 boys and 24 girls) aged 19-41 years (median, 29 years) had follow-up. Of these, 37 (71%) individuals had bilateral normal kidney function at follow-up; seven (14%) had normal total renal function but unilateral deteriorated kidney, and eight individuals (15%) had deteriorated kidney function. Adult individuals with bilateral kidney deterioration had a significant higher frequency of diagnosed detrusor overactivity at childhood urodynamics (63%) compared to those with normal function of both kidneys (24%). In total, 48% of the 52 myelomeningocele individuals were continent at follow-up. Continence surgery was performed in eight patients, nine used anticholinergica, three had regular botulinum toxin detrusor injections, and 27 used clean intermittent catheterization. CONCLUSIONS: Overall, 15% of patients had impairment of kidney function and 48% were urinary continent. Considering the present age distribution of the present study population, this figure appears to be comparable to the data in the literature. Urodynamic findings in childhood were predictive for later kidney deterioration.