Initial urologic management of myelomeningocele.

Disordered innervation of the detrusor musculature and external sphincter in patients with myelomeningocele adversely affects bladder function and potentially threatens the upper urinary tracts. Children with this condition can be categorized into high and low- risk groups for secondary damage from a neurogenic bladder based on intravesical pressure. Those with elevated pressure are at risk for hydronephrosis or reflux,and evidence suggests that early management of high pressure protects the bladder from additional damage, reducing the need for augmentation. Management decisions made during infancy potentially impact long-term outcomes for preserving renal function and achieving urinary continence. This discussion focuses on the initial urologic care of infants with myelomeningocele, emphasizing the controversy regarding urodynamic versus radiologic-based management of the neurogenic bladder.