Korean J Urol.  2007 Apr;48(4):452-457. 10.4111/kju.2007.48.4.452.

The Change of Bladder Function after Neurosurgery in Patients with Lipomyelomeningocele

• Moon KH
• Lee SK
• Ra YS
• Kim JB
• Kim KS

• KMID: 1997115
• DOI: http://doi.org/10.4111/kju.2007.48.4.452

Abstract

PURPOSE
To prevent further neurological deterioration by tethering of the spinal cord, an early surgical procedure for asymptomatic lipomyelomeningocele (LMMC) can be performed. The neurogenic bladder patterns, degree of improvement according to timing of surgery, and the relationship between the change in the upper urinary tract and neurogenic bladder pattern were evaluated.
MATERIALS AND METHODS
A retrospective chart review was performed on all 39 patients, before and after primary neurosurgical repair of LMMC, who presented between 1996 and 2003.
RESULTS
Preoperative urodynamics (UDS) revealed a neurogenic bladder in 23 patients (59%). Of these 23 patients, 16 had a hyperreflexic and 7 an areflexic bladder. Of the 16 who had a hyperreflexic bladder, 4 and 2 were changed to normal and areflexic bladders, respectively, but 10 remained unchanged postoperatively. In 3 patients repeated UDS was performed, with 1 remaining unchanged, but 2 changed to an areflexic bladder. Of the 7 patients with an areflexic bladder, 1 changed to a hyperreflexic bladder, but 6 remained unchanged postoperatively. All 3 patients who underwent a repeated UDS remained unchanged. Hydronephrosis was noted on ultrasonography in 3 patients. The degree of improvement according to the timing of surgery was not statistically significant. All 16 patients who had a normal bladder remained unchanged postoperatively, and 2 patients who underwent repeated UDS changed to a hyperreflexic bladder.
CONCLUSIONS
Even when pre- and postoperative UDS reveal a normal bladder function, long-term follow-up through UDS is still required. The use of routine preoperative and periodic postoperative urodynamic evaluations is important in children with LMMC, but without clinically overt symptoms.

Keyword

Urodynamics; Lipoma; Meningomyelocele

MeSH Terms

Child
Follow-Up Studies
Humans
Hydronephrosis
Lipoma
Meningomyelocele
Neurosurgery*
Retrospective Studies
Spinal Cord
Ultrasonography
Urinary Bladder*
Urinary Bladder, Neurogenic
Urinary Tract
Urodynamics

Figure

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  Fig. 1. The change in the urodynamic findings after surgery.

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  Fig. 2. Bilateral vesicoureteral reflux was noted on a voiding cystourethrogram in a patient with a poorly compliant areflexic bladder.

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  Fig. 3. The changes in the urodynamic findings of 8 patients whom underwent repeated postoperative urodynamic study. ∗: patients representing with a preoperative hyperreflexic bladder.

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