Myelodysplasia and Neurogenic Bladder Dysfunction Follow-up

  • Author: Terry F Favazza, MD; Chief Editor: Marc Cendron, MD   more...
 
Updated: Aug 26, 2010
 

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.
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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 success in treating incontinence.[8, 9, 10, 11, 12] However, this treatment is still in its infancy and not yet widely used.
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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.
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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.
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Contributor Information and Disclosures
Author

Terry F Favazza, MD  Physician, Urological Associates of Southern Arizona

Terry F Favazza, MD is a member of the following medical societies: 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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Martin David Bomalaski, MD, FAAP  Pediatric Urologist, Alpine Urology

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.

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

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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