eMedicine Specialties > Pediatrics: Surgery > Urology

Myelodysplasia and Neurogenic Bladder Dysfunction: Follow-up

Author: Terry F Favazza, MD, Consulting Staff, Urologic Associates of Southern Arizona
Coauthor(s): Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Contributor Information and Disclosures

Updated: Mar 27, 2008

Follow-up

Further Outpatient Care

  • General follow-up care
    • That patients require lifelong supervision and monitoring of renal function cannot be stressed enough. Renal failure can progress slowly or occur with startling rapidity.
    • Check postvoiding residual volumes every 6-12 months and renal function (BUN and creatinine levels) yearly.
    • Perform renal ultrasound yearly.
    • Many advocate a yearly urodynamic study for the first 5 years of life, followed by biennial evaluation.
    • Perform a repeat urodynamic study any time the patient experiences any change in neurologic symptoms.
  • Tethered cord
    • As children age, different growth rates of the vertebral bodies and the spinal cord can add a dynamic element to the lesion. Fibrosis surrounding the cord at the site of meningocele closure can tether it during growth. This can lead to changes in bowel, bladder, and lower extremity function. If these are noted, evaluation using MRI is indicated.
    • From the urologic standpoint, an MRI and a repeat urodynamic study are warranted when the patient has a change in symptoms or undergoes any neurosurgical procedure.

Inpatient & Outpatient Medications

  • Antibiotics: Antibiotics are used when indicated to treat acute infections. In patients with vesicoureteral reflux, antibiotics are often used as prophylaxis to prevent UTIs.
  • Anticholinergics: Anticholinergic medications help suppress involuntary and uninhibited bladder contractions. This serves to decrease urgency and incontinence and to potentially increase the bladder's functional storage capacity.
  • Alpha agonists: The role of alpha agonists is to increase tone at the bladder neck, initiating a state of urinary retention in an effort to decrease incontinence. Thus far, the therapy has had limited use in patients with myelodysplasia.
  • Botulinum toxin: Studies have reported the use of botulinum toxin directly injected into the detrusor of children with myelodysplasia with some success in treating incontinence.8,9  However, this treatment is in its infancy in respect to children with myelodysplasia.

Prognosis

The prognosis for patients with myelodysplasia has improved dramatically over the past decades.

  • Neurosurgical techniques and antibiotics have improved, and far fewer infants die of CNS infections and complications related to closure of the defect.
  • Since the introduction of IC, incontinent urinary diversion is no longer performed with the same frequency as in the past, leading to greatly reduced operative morbidity and mortality. Many patients can be treated with CIC alone or with adjunctive pharmacotherapy and never require surgery.
  • In selected patients, bladder augmentation and continence surgery may provide medical benefits and an improvement in the patient's quality of life.

Patient Education

Starting at birth and as the patient ages, parents and patients need to be educated regarding the many issues associated with living with myelodysplasia.

  • Teach parents and patients the skills of catheterization, how to recognize infection, the need to alleviate constipation, the importance of watching for changes in symptoms, and the facts regarding sexual issues.
  • Constantly remind parents and patients of the need to adapt to new problems and the need for lifelong observation by health care providers.
  • When they are able, encourage patients to become involved in their own care because, eventually, they will be responsible for looking after themselves.

Miscellaneous

Special Concerns

  • Latex allergy
    • Believed to be related to the recurrent exposure of peritoneal and mucosal surfaces to medical devices containing latex throughout childhood, a remarkable number (in some studies as high as 45%) of patients with myelodysplasia develop hypersensitivity to latex. Reactions range from contact dermatitis to anaphylaxis and cardiovascular collapse.
    • Consider all patients with myelodysplasia of spina bifida to have a latex allergy and make every effort to avoid exposure to latex from birth. Gloves, catheters, crib pads, and bottle nipples are all potential sources and may exacerbate hypersensitivity.
  • Sexuality
    • The topic of sexuality, although not an issue in childhood, becomes progressively more important as the patient ages. Sexuality has historically been ignored in individuals with myelodysplasia. Patients with myelodysplasia have sexual encounters, and studies indicate that at least 15-20% of males are capable of fathering children and 70% of females can conceive and carry a pregnancy to term.
    • Additionally, although puberty in boys with myelodysplasia appears to occur at the same age as puberty in healthy boys, menarche can begin 2 years earlier than usual in girls.
    • For these reasons, counseling patients in early adolescence regarding sexual development is important.
 


More on Myelodysplasia and Neurogenic Bladder Dysfunction

Overview: Myelodysplasia and Neurogenic Bladder Dysfunction
Differential Diagnoses & Workup: Myelodysplasia and Neurogenic Bladder Dysfunction
Treatment & Medication: Myelodysplasia and Neurogenic Bladder Dysfunction
Follow-up: Myelodysplasia and Neurogenic Bladder Dysfunction
References
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References

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Further Reading

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Keywords

neurospinal dysraphism, meningocele, myelomeningocele, lipomeningocele, spina bifida, neural tube defects, neurogenic bladder, spinal dysraphism, spina bifida occulta, dysraphism, renal function, incontinent urinary diversion, myelodysplasia, neurogenic bladder dysfunction, Arnold-Chiari malformation, sacral agenesis, voiding dysfunction, diabetes mellitus, vesicoureteral reflux, renal scarring, urinary tract infections, UTI, renal failure, pyelonephritis, detrusor hyperreflexia, dyssynergia, hypospadias, cryptorchidism, hydroceles, hernia

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Contributor Information and Disclosures

Author

Terry F Favazza, MD, Consulting Staff, Urologic Associates of Southern Arizona
Terry F Favazza, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Arizona Medical Association, California Medical Association, Endourological Society, and Oregon Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Howard M Snyder III, MD, Professor, Department of Surgery, Division of Pediatric Urology, University of Pennsylvania School of Medicine
Howard M Snyder III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Martin David Bomalaski, MD, FAAP, Pediatric Urologist, Alaska Southcentral Urology Specialists
Martin David Bomalaski, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
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