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CHANGES OF BLADDER FUNCTION DURING PUBERTY IN PATIENTS WITH
SPINAL DYRAPHISM
Sang Woon KIM
1
, Yoonhye JI
2
, Sang Hee SHIN
2
, Yong Seung LEE
1
, Young Jae IM
1
, Ki Ho KIM
3
and Sang Won HAN
1
1) Yonsei University College of Medicine, Department of Urology, Urological Science Institute, Seoul, KOREA (REPUBLIC
OF) - 2) Yonsei University Health System, Bladder-Urethra Rehabilitation Clinic, Seoul, KOREA (REPUBLIC OF) - 3)
Dongguk University College of Medicine, Department of Urology, Séoul, KOREA (REPUBLIC OF)
PURPOSE
The aim of this study was to investigate the changes of bladder function in children with spina dysraphism during
puberty.
MATERIAL AND METHODS
From our database of spina bifida clinic, patients aged older than 16 years were included following exclusion criteria
below : patients who had spinal surgery older than 2 years, follow up loss, no proper evaluation of bladder or renal
function during follow up over 3 years. Thirty-seven patients were included finally. Hostile bladder was defined as high
end filling pressure (40 cmH2O or greater), poor compliance (less than 10 ml/cm H2O) and high detrusor leak point
pressure (40 cmH2O or greater) was seen together. Impaired renal function was defined as relative function loss 10%
or greater or renal scarring on DMSA scan.
RESULTS
Of 37 patients included, 13 were diagnosed as myelomeningocele (MMC) and 24 were lipomyelomeningocele (LMMC).
Mean follow up duration was 210.75±52.54 months and 33 patients (89.2%) used CIC on their last follow up. In a serial
follow up period, the prevalence of hostile bladder was sharply increased during puberty in patients with LMMC while
gradual increase was seen in patient with MMC (Log-rank, p<0.001). Impaired renal function on DMSA scan was seen in
6 patients, 4 of these were demonstrated after their puberty. Of 14 patients showing incontinence before pubertry, 10
patients (71.4%) demonstrated improvement of incontinence after puberty. The prevalence of hostile bladder was
significantly increased after pubertal period (35.1% to 62.2%, p=0.003), which was more obvious in patients with LMMC
(12.5% to 45.8%, p=0.002) than MMC (76.9% to 92.3%, p=0.399).
CONCLUSIONS
This study demonstrates that the prevalence of hostile bladder in patients with spinal dysraphism was significantly
increased following puberty. Also, a significant number of patients showed impaired renal function on DMSA scan during
puberty, suggesting attentive monitoring is required on their pubertal period to prevent deterioration of bladder and
renal function .