Bladder-sphincter dysfunction in myelomeningocele

Pediatric urodynamics taught us that detrusor-sphincter dyssynergia creates a bladder outlet obstruction in about 50% of any population of children wi th myelomeningocele. This functional obstruction causes renal damage due to obstructive uropathy, exactly the same way as a congenital anatomical uret hral obstruction does. Pediatric urodynamics also taught us that in childre n with myelomeningocele pelvic floor activity and detrusor activity can be abnormal (hyperactive or inactive) completely independent from each other. These insights have changed the management of myelomeningocele. Children wi th overactivity of the pelvic floor can be singled out at infant age, and s tarted on clean intermittent catherization, to prevent obstructive uropathy and preserve renal function. Children with detrusor overactivity can be si ngled out too at very early age, and treated with anticholinergics, to prev ent irreversible structural damage to the detrusor and preserve normal blad der capacity and compliance.