Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country

Authors

  • Vishesh Dikshit Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India http://orcid.org/0000-0003-2405-7573
  • Abhaya Gupta Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India
  • Prashant Patil Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India
  • Geeta Kekre Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India http://orcid.org/0000-0001-9920-0958
  • Paras Kothari Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India
  • Apoorva Kulkarni Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20174514

Keywords:

Continence, Long term outcomes, MMC, Spina bifida, Social acceptance

Abstract

Background: Meningomyelocele (MMC) and meningocele (MC) are the two most common types of neural tube defects (NTD) seen. Some of the problems associated with care of these patients are psychological stress is parents, average financial condition of caretakers, ignorance on the part of parents, local physicians for management of this condition, very few dedicated Spina bifida clinics and social stigma associated with this condition. The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care involving paediatric surgeon, paediatrician, nursing staff, occupational therapist, physiotherapist, social worker, parents and patients themselves. The aim of this study is to discuss our experience in initial management of meningomyelocele (MMC) and hydrocephalus and long-term management of bladder/bowel incontinence and foot deformity in a tertiary care hospital of a developing country.

Methods: A retrospective nonrandomized observational study was conducted in the department of pediatric surgery at a tertiary hospital, from August 2008 to October 2015. Overall 145 patients of meningomyelocele were included in the study. Patients were managed according to our institution protocol.

Results: 68.2% MMC patients were repaired primarily. 24.1% of total patients needed Y-V plasty skin advancement flap. 7.5% patients needed synthetic patch for dural closure. 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth. 5.5% patients were incontinent after MMC repair. 8.2% patients had decreased lower limb power after MMC repair. 28.9% patients needed VP shunt for gross hydrocephalus before MMC repair. 51.03% patients needed VP shunt after MMC repair. 20% patients did not require VP shunt in the present series. 13.1% patients in the present series had urinary incontinence. 11.03% patients had fecal incontinence. 73.6% patients with urinary incontinence were successfully managed with conservative treatment. 87.5% patients with fecal incontinence responded to conservative treatment. Bladder augmentation was done in 26.3% of neurogenic bladder dysfunction patients. 60% of these patients had dry interval of more than 4 hours. MACE was done in 12.5% of neurogenic bowel dysfunction patients. 2 patients required simultaneous bladder augmentation, Mitrofanoff’s and MACE procedure. One of these patients achieved a dry interval of >4 hour.

Conclusions: Successful rehabilitation of children with MMC can be achieved with parental education and support, dedicated clinicians, trained nursing staff, regular follow-up and low threshold for diagnosing clinical deterioration and proactive management to prevent further clinical deterioration.

References

Rosano A, Smithells D, Cacciani L, Botting B, Castilla E, Cornel M, et al. Time trends in neural tube defects, prevalence in relation to preventive studies: an internal study J Epidemiol Community Heath. 1999;53:630-5.

Snow-Lisy DC, Yerkes EB, Cheng EY. Update on urological management of SB from prenatal diagnosis to adulthood. J Urol. 2015;194:288-96.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: a review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012;9:32-9.

Dik P, Klijn AJ, van Gool JD, de Jong-de Vos van Steenwijk CC, De Jong TP. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol. 2006;49:908-13.

Hopps C, Kropp. Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close follow-up. J Urol. 2003;169:305-8.

de Jong TP, Chrzan R, Klijn AJ, Dik P. Treatment of the neurogenic bladder in spina bifida. Pediatr Nephrol. 2008;23(6):889-96.

Lapides J, Diokno AC, Silber SM, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol 1972;167(4):1584-6.

Kasabian NG, Bauer SB, Dyro FM, Colodny AH, Mandell J, Retik AB. The prophylactic value of clean intermittent catheterization and anticholinergic medication in newborns and infants with myelodysplasia at risk of developing urinary tract deterioration. Am J Dis Child. 1992;146(7):840-3.

Thorup J, Biering-Sorensen F, Cortes D. Urological outcome after myelomeningocele: 20 years of follow-up. BJU Int. 2011;107(6):994-9.

Roberts JP, Moon S, Malone PS. Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure. Br J Urol. 1995;75(3):386-9.

Schöller-Gyüre M, Nesselaar C, van Wieringen H, van Gool JD. Treatment of defecation disorders by colonic enemas in children with spina bifida. Eur J Pediatr Surg. 1996;6(1):32-4.

Van Savage JG, Yohannes P. Laparoscopic antegrade continence enema in situ appendix procedure for refractory constipation and overflow fecal incontinence in children with spina bifida. J Urol. 2000;164:1084-7.

Goepel M, Sperling H, Stöhrer M, Otto T, Rübben H. Management of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema. Urology. 1997;49:758-61.

Bannink F, Idro R, van Hove G. Parental stress and support of parents of children with spina bifida in Uganda. Afr J Disability. 2016;5(1):225.

Holmbeck GN, Devine KA. Psychosocial and family functioning in Spina Bifida. Developmental Disabilities Research Reviews. 2010;16(1):40-6.

Downloads

Published

2017-09-27

Issue

Section

Original Research Articles