The urodynamic profile of myelodysplasia in childhood with spinal closure during gestation

Purpose: Spinal dysraphism is the most common cause of neurogenic bladder d ysfunction in newborns. Urodynamic findings in these patients include uninh ibited bladder contractions, bladder areflexia, decreased compliance and de trusor-sphincter dyssynergia. Early urodynamic studies are recommended for spina bifida to help identify bladder characteristics that may cause a risk of upper tract deterioration. We recently evaluated a new early type of in tervention involving closure of the neural tube defect during gestation in 25 patients at our institution. We hypothesize that this procedure results in decreased exposure of the spinal cord to amniotic fluid, which may impro ve neurological function. To date we have evaluated 16 of the 25 patients w ith video urodynamics. We compared the results to those in the literature o n patients with myelomeningocele and without prenatal intervention. Materials and Methods: We performed urodynamic testing in 16 patients with a mean age of 6.5 months, including cystometrography, fluoroscopic evaluati on of filling and voiding, pelvic floor electromyography and post-void resi dual urine measurement. In addition, we retrospectively reviewed renal ultr asound, voiding cystourethrography, catheterization need, number of urinary tract infections and medication in these cases. Results: Uninhibited detrusor contractions and an areflexic bladder were id entified in 6% and 43% of patients, respectively, while 19% had decreased c ompliance and 75% had leak point pressure greater than 40 cm. water. Mean b ladder capacity was 40 cc and 31% of patients had much lower capacity than expected for age. Previous renal ultrasound and voiding cystourethrography showed evidence of upper tract dilatation and reflux in 2 cases, respective ly. Intermittent catheterization and anticholinergic therapy were required by 1 patient each and 1 had a significant urinary tract infection. Conclusions: Urodynamic findings in this population are comparable to those previously reported in the literature in patients with spina bifida withou t prenatal closure of the spinal defect. The lower incidence of urinary tra ct infection and reflux in our study probably represents more aggressive ea rly urological management rather than neurological improvement. These urody namic studies were performed early in life and future evaluation may ultima tely reveal improved bladder function compared with that in others with mye lodysplasia. However, at this time we recommend that patients who undergo s pinal cord defect closure during gestation be evaluated and treated in the same manner as those with myelomeningocele but without fetal intervention.