Neurogenic bladder: Myelomeningocele, Occult Spina Bifida, and Tethered Cord

Abstract

Spinal dysraphism occurs in patients with spina bifida aperta or occulta and will affect the functionality of bladder and sphincter complex. The incidence has changed over the past decades from 1:3000 live births to 1:6000 as a result of the use of folic acid and also as a result of early abortion. Treatment is directed to preservation of bladder and kidney function. As long as bladder volume with low pressures is achieved, kidney function will be fine. Low pressures are possible by using antimuscarinic medication or in some cases operations. Intermittent catheterization is needed to ensure proper bladder evacuation. In most cases, it is possible to become dry in between catheterization, or perhaps some incontinence remains during transfers or straining. Colonic washouts have improved the quality of life dramatically: almost all patients can obtain pseudo-continence for stool. Since a few years, it is possible to restore some sexual function by making a neural bypass between an ilioinguinal nerve and a dorsal nerve of the penis. Attention for tethering and scarring of kidneys is the mainstay of the treatment.