275
19–22 APRIL, 2017, BARCELONA, SPAIN
RESULTS
Thirty one patients were identified. Tumor histology included mature (70% n=22) and immature
(29% n=9). Median age at surgery was 9 months (1 day - 11 years). Median follow up was
10.2 years (0.38-23). In twenty four (77,4%) excision was completed in the first surgery while seven
patients (22,5%) required multiple surgeries. Median volume was 155cm3 (10-944cm3). Seven
patients (22.5%) developed rectal dysfunction. Six patients (19.3%) presented urological complica-
tions including detrusor hiperactivity and hiporreflexia. Regression analysis showed significance
association between functional sequelaes and multiples surgeries (p-valor
CONCLUSIONS
Rectal and bladder dysfunction after SCT are not uncommon, especially in children who required
more than one surgery. Therefore, first attempt and complete excision is crucial. These children
need a close follow up in order to detect early neurogenic bladder symptoms.
13:21–13:36
Discussion
S25-10 (P without presentation)
DOES PRO-ACTIVE MANAGEMENT AVOID UPPER
URINARY TRACT DETERIORATION IN PATIENTS
WITH MYELOMENINGOCELE?
Sibel TIRYAKI
1
, Raziye ERGUN
2
, Ibrahim ULMAN
3
and Ali AVANOGLU
2
1) Ege University Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology,, Izmir, TURKEY
- 2) Ege University, Pediatric Surgery Division of Pediatric Urology, Izmir, TURKEY - 3) Ege University, Pediatric Surgery
Division of Pediatric Urology, Izmir, TURKEY
PURPOSE
Early intervention for bladder dysfunction in myelomeningocele is promoted to prevent upper
urinary tract deterioration. The aim of this study is to reveal the long-term outcomes of pro-active
management.
PATIENTS AND METHODS
Hospital records of patients with myelomeningocele admitted to our outpatient clinic between years
1994-2015 were reviewed retrospectively. Patients with a follow-up of more than 5 years were
included in the study. Multivariate analysis of data including age at admission, initiation of anticholin-
ergic therapy, bladder status, renal damage, need for augmentation and continence was performed.
RESULTS
Of the 469 patients with myelomeningocele, 151 patients had a follow-up of more than 5 years.
Median follow-up was 9 (5-19) years. Median age at admission was 2 (0-22). New renal scar devel-
opment was significantly related with UTI (p=0.005), the presence of a scar in the initial scintigraphy
(p=0.001), and low compliance to follow-up protocol (p=0.002). No other relation with eventual
outcome was found including age at admission or initiation of medical therapy. Sixty-seven patients
were admitted in infancy and 49 were compliant with follow-up. These 49 patients with optimal
management were then compared with the remaining. In this group, 10 had new scar development
and 15 had scars in the eventual scintigraphy which was 37 and 50 in the remaining group with
102 patients. No significant difference was observed between groups.
CONCLUSIONS
Analyses of the long-term follow-up of patients with myelomeningocele failed to show the benefit of
pro-active management. The presence of renal scars at admission seems to be an independent risk
factor for new scar development reminding genetic predisposition theories.