DEVELOPMENT OF THE URODYNAMIC PATTERN IN INFANTS WITH MYELOMENINGOCELE

Objective To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract. Patients meth ods Thirty-four infants with MMC were investigated using cystometry, m icturating cystourethrography and urography at 1, 4 and 10 months of a ge.Results Detrusor contractility was characterized by an increase in activity, with hyper-reflexia in 45% initially, increasing to 65% at t he 4-month investigation. During the same period, the number of infant s with areflexia decreased from 25% to 12%. Between 4 and 10 months, t here were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the fir st and fourth month. The number of patients with elevated outlet resis tance increased only slightly during the first year, from 32% of all i nfants at the initial investigation to 40% at the 10-month follow-up. Vesico-ureteric reflux was detected in 12 of the patients during the y ear, with live already diagnosed at the first investigation. Almost al l refluxes were cured with clean intermittent catheterization, with ad ditional Pharmacological therapy in two patients; one patient required a vesicostomy. Conclusions This study indicates that detrusor activit y, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in acti vity and occurred mostly between the first and fourth months of age. T here was a strong correlation between the occurrence of reflux and poo r compliance, hypercontractility and outlet obstruction.