Development of the upper urinary tract in myelomeningocele and consequent urological care.

The findings in the upper urinary tract of 58 patients with MMC and neurogenic bladder dysfunction are discussed and therapeutical consequences are considered. In a group of 28 neonates, investigated within the first three months of life, only 10% showed some abnormalities of the upper urinary tract and (or) reflux, in a second group of 21 children, over the age of 2 years when first seen, the occurrence rate of dilatation of the upper urinary tract and of pyelonephritis signs was already doubled, whereas adults with operated MMC showed in 75% severe pathological changes. The situation of neonates born with MMC may be in some aspects compared to patients suffering from acute traumatic cord lesion with neurogenic bladder dysfunction. It was already shown that, in spite of neurogenic bladder dysfunction, it is possible in parapegics by appropiate and mainly conservative treatment to prevent progressive destruction of the upper urinary tract, once considered to be unavoidable. The key to better results in the children with MMC should therefore be early and prompt care and close follow-up. The importance of regular bladder emptying, low dosage, long-term antibiotic treatment and measures like forced urethral dilatation and sphincterotomy is stressed. Our results so far in neonatal urological care of children with MMC are encouraging.