Urodynamic and Imaging Findings in Myelomeningocele Infants May Predict Need for Future Augmentation Cystoplasty

Summary Introduction Urologic issues are persistent and important causes of morbidity and mortality in myelomeningocele patients. Classically, patients with elevated bladder pressures despite adherence to clean intermittent catheterization and pharmacotherapy undergo augmentation cystoplasty (AC). Currently, there is little understanding of which infants are more likely to require later AC. Objective In this context, we studied whether unfavorable urodynamic or imaging findings in myelomeningocele patients during infancy could predict future AC. We hypothesized that infants born with elevated bladder pressures, vesicoureteral reflux (VUR), and/or hydronephrosis would be more likely to undergo AC. Study design We retrospectively identified myelomeningocele patients at our institution followed since infancy ( Results 97 patients met inclusion criteria. Median follow-up time was 13.8 years. AC was performed in 17 patients (17.5%) at a median age of 114 months (9.5 years). DLPP/EFP was greater than 40 cm H2O in 34.0% (33/97) of infant cystometrogram studies, while 30.9% (30/97) had VUR on infant VCUG and 20.6% (20/97) had hydronephrosis on infant renal ultrasound. Patients with DLPP/EFP greater than 40 cm H2O or VUR during infancy were more likely to undergo AC (p = 0.02, p = 0.03, respectively). Binomial logistic regression revealed that DLPP/EFP greater than 40 cm H2O (OR 4.28, 95% CI 1.34 – 13.62) and VUR (OR 3.73, 95% CI 1.18 – 11.77) were independent risk factors for future AC. Discussion Myelomeningocele infants with elevated bladder pressures and VUR should be closely monitored with urodynamic testing and imaging studies. Parents can be counseled regarding the potentially greater risk for future AC in these patients. Nonetheless, the majority of high-risk infants will safely avoid AC with conservative management.