Sphincter Behaviour in Myelomeningocele

Abstract

Four hundred and two videourodynamic studies were performed on 207 children with neuropathic vesicourethral dysfunction due to myelomeningocele. The children were divided into three groups (contractile, intermediate and acontractile) according to the urodynamic behaviour of their bladders, and the behaviour of the bladder neck and distal sphincter mechanism was assessed in each group. The bladder neck may be competent or incompetent in children with contractile bladders but is never obstructive, and is always incompetent in children with either intermediate or acontractile bladders at their usual bladder volumes. The distal sphincter mechanism is nearly always dynamically obstructive (detrusor-sphincter dyssynergia) in children with contractile bladders but is rarely if ever incompetent, whereas in children with intermediate or acontractile bladders, both (static) distal sphincter obstruction and sphincter weakness incontinence exist to some degree, although the predominance of one of these may mask the existence of the other unless it is specifically looked for or some therapeutic manoeuvre unmasks it. The main conclusion from this study is that, with the possible exception of those few children with more minor partial cord lesions, dysfunction of one or both sphincter mechanisms is the rule in congenital cord lesions.

Urethral pressure response to cough and voluntary perineal contraction in men without previous pelvic surgery

“…This defect in urethral response to cough is not usually checked in men with stress incontinence. However, stress incontinence was explored in some men with no prior surgery and with bladder, urethral, and perineal denervation [Woodside and McGuire, 1979;Woodside, 1982;Mundy et al, 1985]. In these patients, the stress incontinence was explained by an open bladder neck appearing in standing position.…”

Urine Production and Bladder Function in Fetuses with Open Spina bifida

“…It was suggested that this classification carries important clinical, behavioral, thera peutic and prognostic implications [4,5], Although the authors gave no data as to the spinal injury level, the apparent lack of rela tion between urinary function and vertebral defect is stressed elsewhere [2,3]. They also did not specify any sex difference.…”

“…For exam ple, the majority of children with OSB suffer from varying degrees of bladder and urethral sphincter dysfunction [2][3][4], The type and severity of neurogenic dysfunction are unique for each child and are related to the degree of neuronal damage which often ex tends beyond the limits of the bony lesion [2].…”

“…In a videourodynamic study of 207 chil dren (1 month to 16 years old) with OSB, Mundy et al [4] described three types of bladder dysfunction: (1) contractile bladders with detrusor activity capable of giving use ful bladder emptying (35% of the children); in 48% of these the bladder neck was incom petent, and, although the distal sphincter mechanism was competent in all cases, in 95% there was detrusor sphincter dyssynergia (i.e. failure of relaxation of the urethra during a detrusor contraction); (2) acontractile bladders with no demonstrable detrusor activity (25% of the children), and (3) inter mediate bladders with detrusor activity present but insufficient to cause useful blad der emptying (40% of the children).…”

A small cloud on the horizon.

“…CT showed multiple lesions in the cerebral hemispheres, characterized by rim enhancement and modest mass effect (Fig. 1) ' -__-__- Iymphoma may be difficult [4]. Increases in titers in tests for Toxop!asma and responses to empirical therapy may suggest toxoplasmosis.…”