The incontinent myelodysplastic patient.

Urinary incontinence is a socially devastating aspect of the lives of many myelodysplastic children. Incontinence results from abnormal bladder storage function, urethral sphincteric incompetence, or both. Unfortunately, the vesicourethral dysfunction in an individual patient cannot be discerned from the level of the vertebral defect or the coexisting neurologic deficits. Therefore, thorough urodynamic assessment is required to identify altered physiology precisely and to guide rational treatment. Our therapeutic armamentarium includes external devices, intermittent self-catheterization, pharmacologic therapy, prosthetics, electrical stimulation, biofeedback, and innovative surgical procedures. Comprehensive evaluation, thoughtful tailoring of therapy to the individual patient, and a commitment by the urologist to indefinite follow-up will enable most patients to attain social continence while preserving renal function.