Neurogenic bladder dysfunction in patients with myelomeningocele.

PURPOSE OF REVIEW: The general management strategies in children with myelodysplasia are widely accepted, however diagnostic and therapeutic details still need to be discussed and clarified. RECENT
FINDINGS: Ten articles are reviewed. Two articles are dealing with general clinical aspects; one underlines the need for urodynamics as a prerequisite for an adequate treatment strategy, the other recommends to evaluate adolescents and adults with myelodysplasia, because only the ultimate outcome allows a judgement of how effective our efforts are to achieve the goals. Increased excretion of glycosaminoglycan in myelodysplasia children above 5 years of age could become a marker for beginning bladder damage and deserves further interest. The question whether children with normal urodynamics after closing the spinal cord should be followed or not is clearly answered in a further article which also discusses the results of detethering in these patients. Four articles report on pharmacotherapy with new substances or new ways of application (intravesical oxybutynin, extended release oxybutynin formulation, intravesical resiniferatoxin). The results of collagen injections in children with neurogenic sphincter underactivity clearly demonstrate that the long-term results are disappointing. Last, but not least, a retrospective review on acute abdominal symptoms and signs in children with myelodysplasia clearly shows that these patients should be transferred to a centre because of complex reasons and treatment modalities.
SUMMARY: Urodynamics - abnormal or normal - are a prerequisite for adequate treatment and follow-up in children with myelodysplasia. More studies should focus on adolescents and adults with myelodysplasia to judge the effectiveness of our diagnostic and therapeutic efforts. New ways of application and new developments in pharmacotherapy to relax the overactive detrusor may possibly further decrease the need for surgery in the future. With regards to sphincter underactivity, results with collagen injections in this group of patients are disappointing and provide no alternative to operative treatment options.