Abstract General Information

Title

Evolution of vesicoureteral reflux in children with myelomeningocele with a proactive approach.

Introduction and objective

Patients with myelomeningocele have a high rate of vesicoureteral reflux and urinary tract infections that can lead to progressive deterioration in renal function. Proactive management has decreased the frequency of urinary tract infections and stopped or prevented the deterioration of renal function. The objective of our study is to analyze the evolution of patients with myelomeningocele and associated vesicoureteral reflux during the first 5 years of life.

Method

Prospective, observational and analytical study of a cohort of patients diagnosed with myelomeningocele and proactive urological management from birth to 5 years of age, during the period 2015-2021 in a single institution. Videourodynamic variables and renal DMSA were compared in the first and last year of follow-up. The Student's T test was applied for the comparison of means and the Chi-square test for the correlation between variables. The significance level used was <0.05. The proactive approach included clean intermittent catheterization from the first days of life and anticholinergics after the first videourodynamics if necessary.

Results

82 patients with myelomeningocele were included, 13 cases (15.85%) presented reflux in the first videourodynamic study at a mean age of 6 months (R: 2–15 months). 61.5% had grade III and only 2 patients had high grade reflux (univ – bilat). During the follow-up period, 61.5% resolved reflux within 2 years (p = 0.035). The finding of impaired accommodation in the first videourodynamic study was the only factor significantly associated with urinary trac infection recurrence despite proactive management (p = 0.024). Abnormal renal function by DMSA scintigraphy was 30% and 36% during the first evaluation and the fifth year of life.

Conclusion

Vesicoureteral reflux in the first evaluation of neurogenic bladder in children with myelomeningocele is not uncommon. The proactive approach decreased the proportion of vesicoureteral reflux within 2 years in more than half of the cases. Reduced wall compliance during the first evaluation was related to the recurrence of urinary tract infections. Abnormal renal function had no significant changes in the first 5 years of life.