Urological outcome after myelomeningocele: 20 years of follow-up.

OBJECTIVE: • 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. PATIENTS 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.