Urological outcome of patients with cervical and upper thoracic myelomeningocele

Purpose: We determined the incidence of voiding disorders and upper tract d eterioration in children with cervical and upper thoracic level myelomening ocele. Materials and Methods: We retrospectively reviewed the neurosurgical and ur ological presentation, evaluation and treatment of 11 patients of whom 8 ha d cervical and 3 had upper thoracic myelomeningocele. There were 7 female a nd 4 male patients 10 months to 39 years old (mean age 12 years). All patie nts were ambulatory and 5 of 11 (45%) had hydrocephalus. Although a voiding history was obtained by a neurosurgeon in all patients, only 9 had undergo ne a formal urological evaluation, including video urodynamic assessment in 5. Results: No patient had an increased post-void residual and none had ever b een placed on intermittent catheterization. Tethered spinal cords from caud al fixation (thickened filum terminale and a lipomyelomeningocele) were pre sent in 2 patients with urinary incontinence of whom 1 had recurrent cystit is. Imaging studies of the upper tracts were normal in all 9 patients and v ideo urodynamics were normal in 3 of 5. No patient has required urological operative intervention. Conclusions: To our knowledge, this study represents the largest reported s eries of patients with cervical and upper thoracic myelomeningocele who hav e undergone urological evaluation. Our experience suggests that patients wi th cervical and upper thoracic myelomeningocele have a low risk of voiding disorders and upper tract deterioration unless other conditions, such as a congenital tethered cord, are present. Additional reports of children with cervical and upper thoracic myelomeningocele are necessary to confirm these findings.