Incidence of urinary tract complications with myelomeningocele

Cass, Alexander S.; Luxenberg, Michael G.; Johnson, C.F.; Gleich, Paul

doi:10.1016/0090-4295(85)90492-3

Cited by 23 publications

(7 citation statements)

References 19 publications

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“…NBD is accompanied by a number of well-described changes in normal bladder function: loss of voluntary control of micturition, bladder hyperactivity, bladder/sphincter dyssynergia, increased vesical pressure, and bladder hypertrophy (2,7,10,35,47,60). The natural history of NBD, however, remains controversial and has not been formally assessed.…”

Section: Discussionmentioning

confidence: 97%

Structural and functional characterization of bladder smooth muscle in fetal rats with retinoic acid-induced myelomeningocele

Danzer

Kiddoo²,

Redden³

et al. 2007

American Journal of Physiology-Renal Physiology

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Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysfunction (NBD). We recently developed a novel retinoic acid (RA)-induced MMC model in fetal rats. The objective of this study was to use this model to assess functional and structural characteristics of the detrusor muscle in MMC-associated NBD. Time-dated pregnant Sprague-Dawley rats were gavage fed 60 mg/kg RA dissolved in olive oil or olive oil alone [embryonic day 10 (E10)]. Bladder specimens from olive oil-exposed fetuses (OIL; n = 71), MMC (n = 79), and RA-exposed-no MMC (RA, n = 62) were randomly assigned for functional and histopathological evaluation and protein analysis. Contractility responses to field and agonist-mediated stimulation (KCl and bethanecol) were analyzed. The expression patterns of alpha-smooth muscle actin, myosin, desmin, vimentin, and collagen III and I were analyzed by immunohistochemistry and Western blotting. Spatial and temporal distribution of nerve fibers within the detrusor muscle was monitored by neurotubulin-beta-III throughout gestation. Neither OIL, MMC, nor RA detrusor responded to field stimulation. MMC bladder strips showed a significant decrease in contractility after KCl and bethanechol stimulation compared with OIL and RA bladders. Bladder detrusor morphology and expression patterns of smooth muscle markers were similar between groups. Detrusor muscles in OIL and RA fetuses were densely innervated, possessing abundant intramural ganglia and nerve trunks that branch to supply smooth muscle bundles. In MMC bladders, neurotubulin-beta-III-positive nerve fibers were markedly decreased with advancing gestational age and were almost completely absent at term (E22). We conclude that the biomechanical properties of fetal rat MMC bladders are analogous to that seen in humans with MMC-associated NBD. Decreased nerve density indicates loss of peripheral neural innervation throughout gestation. The early observation of decreased innervation and decreased contractility in the absence of morphologic abnormalities in muscle structure or extracellular matrix supports a pathophysiological hypothesis that denervation is the primary insult preceding the observed alterations in bladder muscle structure and function.

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Section: Discussionmentioning

confidence: 97%

Structural and functional characterization of bladder smooth muscle in fetal rats with retinoic acid-induced myelomeningocele

Danzer

Kiddoo²,

Redden³

et al. 2007

American Journal of Physiology-Renal Physiology

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“…The association of congenital myelodysplastic conditions (myelomeningocele, sacral agenesis, caudal regression syndrome) and neurovesical dysfunction is well known (Smith, 1972;Smith etal., 1973;Cass et al, 1985). Unless such dysfunction is detected and managed appropriately, it may lead to the upper urinary tract changes of hydroureteronephrosis, vesicoureteric reflux, urolithiasis and, in some cases, deteriorating renal function.…”

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confidence: 99%

Effects of Neurogenic Bladder Dysfunction in utero seen in Neonates with Myelodysplasia

Kopp

Greenfield²

1993

British Journal of Urology

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Twenty neonates with myelodysplasia were prospectively evaluated during the first month of life with urodynamic studies, contrast voiding cystourethrograms (VCUG) and renal ultrasound scans. Ten of 20 infants had abnormal VCUGs--6 with vesicoureteric reflux (VUR) and 4 with bladder trabeculation alone. Only 2/20 neonates had abnormal ultrasounds--both with hydroureteronephrosis secondary to VUR. Elevated leak point pressure (LPP) and/or detrusor sphincter dyssynergia (DSD) were present in 10/20 infants--6 with elevated LPP and DSD, 3 with elevated LPP alone and 1 with DSD alone. Eight of 10 neonates with DSD or elevated LPP had abnormal VCUGs--4 with VUR and 4 with bladder trabeculation alone. Conversely, 8/10 neonates without DSD or elevated LPP had normal VCUGs. Contrast VCUG performed shortly after birth, therefore, is essential for the discovery of bladder trabeculation and reflux. There is a strong correlation between an abnormal VCUG and the presence of DSD and elevated LPP, suggesting that neurogenic bladder dysfunction in utero can lead to these structural abnormalities.

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“…Second, prophylaxis for endocarditis is very important for patients with meningomyelocele who have associated renal defects and may have more frequent episodes of bacteremia from frequent manipulations of the genitourinary tract or from urinary tract infections. 1,13 Third, the possibility of venous air embolism exists whenever the craniofacial operative field is above the heart and is a well-described complication of neurosurgical procedures. 14,15 If an intracardiac connection between the right and left sides of the heart is present, systemic embolization may occur.…”

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confidence: 99%