[Intravesical and intraurethral pressure studies: significance for the prognosis and the treatment of children with myelomeningocele (author's transl)]

Abstract

By statistical analysis of premicturition bladder pressure and urethral pressure in 37 children with myelomeningocele we were able to find four different types of neuropathic bladder dysfunction: 1. Group A (N = 19): No upper urinary tract dilatation and deterioration was seen with normal intravesical and low to normal intraurethral pressure. A conservative approach was warranted. 2. Group B (n = 6): Overflow incontinence due to low intravesical and high intraurethral pressure was found in this group. Upper urinary tract deterioration could be avoided and continence achieved by partial sphincterotomy. 3. Group C (n = 6): Progressive impairment in upper urinary tract dilatation was observed in four out of six children with high intravesical and low intraurethral pressures. In these children we prefer the urinary diversion. 4. Group D (n = 6): A dangerous impairment in upper urinary tract dilatation was found in four out of six children with high intravesical und high intraurethral pressures. When phenoxybenzamin therapy fails urinary diversion is the treatment of choice in this group.