Urinary tract complications of myelomeningocele (spina bifida)
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Angelique Champeau, CPNP
Angelique Champeau, CPNP
- Pediatric Urology Nurse Practitioner
- University of California, San Francisco
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Duncan Wilcox, MD
Duncan Wilcox, MD
- Section Editor — Pediatric Urology
- Professor of Urology, The Ponzio Family Chair in Pediatric Urology
- University of Colorado
Nearly all patients with myelomeningocele have bladder dysfunction (neurogenic bladder). This may adversely affect urinary continence and quality of life, and can also lead to progressive deterioration of the upper urinary tract and chronic renal disease. Thirty to 40 percent of children with myelomeningocele develop some degree of renal dysfunction . Treatment to reduce bladder pressures and minimize urine stasis often prevents or attenuates this complication.
The assessment and management of the urinary tract complications of spina bifida are discussed here. Other aspects of myelomeningocele are discussed separately. (See "Pathophysiology and clinical manifestations of myelomeningocele (spina bifida)" and "Overview of the management of myelomeningocele (spina bifida)".)
Patients with myelomeningocele have problems with storage and/or emptying of urine because the spinal cord lesion disrupts central nervous system control of urinary voiding mechanisms. The abnormalities of lower urinary tract dynamics include:
●High pressure bladder
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- Initial evaluation
- - Ultrasound
- - VCUG, CMG, and EMG (video-urodynamics)
- - Other studies
- Clean intermittent catheterization
- Urinary tract infections
- Prophylactic antibiotics
- Latex precautions
- Bowel management
- Botulinum toxin
- Fetal intervention
- Ureteral reimplantation
- Bladder augmentation
- Bladder neck/outlet surgery
- Continent catheterizable stoma surgery
- SUMMARY AND RECOMMENDATIONS