| Background and ObjectiveMeningomyelocele is the most common inborn nervous system developmental malformation in children. Meningomyelocele's incidence rate is 1/1000 ~ 5000,difference in every region and stock .North- Irish is high to 4.2‰, average incidence rate is 1/3000 in china , Asia is 0.18~1.06‰. It has been reported that average incidence rate is 1: 1000~1: 5000 in newborn in Beijing's Obstetrics hospital 1959. Meningomyelocele may cause limbs paralysis, urination and defecation dysfunction, hydrocephalus, dementia and so on. Urination and defecation dysfunction is very difficult to management in clinical practice. How to select appropriate operation for decrease negatively damage and improve the curative effect is still the clinician's goal.Meningomyelocele usually associate with tethered cord syndrome(TCS), which is very harmful to infant. So more and more pediatrician pay attention to it. "Free sacro- capsule" operation is a new operation to treat TCS due to meningomyelocele.However, the treatment results has not got popular accepted due to lack of objectively evaluation methods. In present study, with urodynamic advance, we can using urodynamic's methord to evaluate "free sacro- capsule" pre- operation and post-operation effect, also evaluate bladder and urethral function providing objective date to support using "free sacro- capsule" operation to treat TCS due to meningomyelocele.The urodynamic records of 20 children with meningomyelocele and TCS were reviewed from 2002 to 2004. Meningomyelocele and TCS children were divided into two groups, one is pre-operation ,the other is post-operation .The differences of urodynamic parameters were compared between two groups.Material and Methods1. Patients Twenty children with Meningomyelocele and TCS were included in this study, who are 2 months ~6 years ,13 boys and 7 girls .2. Methods In this research free uroflowmetry , filling cystometry , pressure-flow- electromyography, urethral pressure measurement were performed in all patients according to the recommendations of the International Children Continence Society (ICCS). Urodynamic parameters inducing maximum cystometric capacity(MCC) , detrusor leak point pressure (DLPP), neurogenic detrusor overactivity (NDOA), detrusor-sphinctor dyssynergia (DSD), bladder compliance (BC) , max free flow rate(MFR), post void residual(PVR), max urethral closure pressure (MCP) and static urethral functional length (SFL) were measured and calculated in all cases. The function of detrusor in voiding was classified as hypercontractile detruor (HD), normal detrusor (ND), detrusor underactivity (DUA) and acontractile detrusor (ACD) according to ICCS. Andall children check X-ray and MRI before operation.Statistical analysisStatistical analyses were carried out using the Statistical Package for Social Sciences (SPSS), version 10.0 for windows. Paired t test and chi-square test was used. P-values of <0.05 were considered to be statistically significant.Results1 All children have none damage after operation. Seven children whose operation cut healing is well; Two children who with leakage of cerebrospinal fluid, recovered after pressure dressing. One child who has urination and defecation dysfunction has healed. Three children who have both lower extremities underactivity improved significantly at two weeks later after operation.2 The PVR and DLPP of post-operation group was significantly decreased than that of pre-operation group (P<0.05) .3 The BC and MCC of post-operation group was significantly higher than pre-operation group (P<0.05)4 There are no significant difference in MCP, SFL, DSD, NDOA, ACD among the pre-opration group and the post-opration group, (p>0.05) .Conclusion1 Management meningomyelocele and TCS using "free sacro- capsule" operation is safe and effective, all children have no damage after operation.2 The BC and MCC of post-operation group was significantly higher than pre-operation group (P<0.05), confirmed this operation can improve serious urinary system symptom.3 The PVR and DLPP of post-operation group was significantly smaller than pre-operation group (P<0.05) , confirmed this operation can decrease upper urinary tract damage development.4 There are no significant difference in MCP, SFL, DSD, NDOA, ACD among the pre-opration group and the post-opration group (P>0.05 ) . |
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