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To characterize the neurourological features of the vesicourethral dysfunction of patients with cogenital myelomeningocele when they reach the adult age.We report the results of the neurourological physical examination and video urodynamic tests of 52 adult patients born with myelomeningocele, with ages ranging from 18 to 14 years (mean age 20.7) controlled over the last 14 years in the Urodynamics Unit of the Hospital Gregorio Morañon in Madrid. The neurological level of the lesion was evaluated in all of them. Following these results we established the diagnosis of the lesion of the three constitutive elements of the vesicourethral innervation (sympathetic, parasympathetic, and pudendal) in order to classify the lower urinary tract neurogenic dysfunction of the patients based on lesion level and type of damaged innervation.The alteration of the perineal sensitivity and diminishment of the anal sphincter tone, in addition to absence of anal voluntary controlled and bulbocavernosus reflex, where the most frequent findings in the neurourological physical examination. Detrusor behaviour was predominantly areflexic (88.4%), in association with diminished bladder compliance in half of the cases. The sphincter was not competent during the filling phase in 51.9% of the cases, competent in 42.3%, and normal in the remainder 5.7%. During the voiding phase we confirmed the absence of sphincter relaxation in 82.6% of the cases. There was a predominance of the lower level of lesion in all three sympathetic, parasympathetic and pudendal nerves. In almost all patients (96.7%) there was lesion in at least two of the three types of innervation. The most frequent neurogenic dysfunction of the lower urinary tract was the multiple inferior motor neuron pure lesion (65.3%), also finding pure superior motor neuron (3.8%), mixed multiple (9.6%), and pure single lesions (1.9%). Three patients presented a normal vesicourethral function.We demonstrated the multiplicity of lower urinary tract neurogenic dysfunction in adult patients with congenital myelomeningocele, its occasional absence, the lack of correlation with the neurological level of the lesion, and the predominance of the multiple inferior motor neuron pure type of lesion. |
