Dynamic ultrasound evaluation of morphological and functional urinary tract characteristics in newborns and young infants with myelomeningocele.

BACKGROUND

Neurogenic bladder is a frequent complication in newborns with myelomeningocele (MMC), increasing the risk of urinary dysfunction and renal injury. Although urodynamic studies are the standard for evaluation, their invasiveness limits their use in neonates and young infants. Dynamic ultrasound offers a potential non-invasive tool for assessing the morphology and function of the urinary tract in these patients.

OBJECTIVE

To evaluate dynamic ultrasound findings in neonates and young infants with MMC compared to healthy controls.

MATERIALS AND

METHODS

This cross-sectional study used dynamic ultrasound to examine the urinary tract characteristics of patients with MMC and controls. The parameters evaluated included bladder wall thickness, bladder capacity, post-void residual volume, detrusor activity, and signs of elevated intravesical pressure, such as urinary leakage, filling of pseudodiverticula, reduction in ureteral emptying, and enlargement of the pelvicalyceal system dimensions during detrusor contractions.

RESULTS

Patients with MMC (n=41) had a mean age of 24.9±13.8 days old (56% males), while controls (n=45) had a mean age of 32.9±17.5 days old (73% males). Compared to healthy controls, MMC patients exhibited significantly higher post-void residual volume and bladder wall thickness, even after adjusting for body weight. Involuntary detrusor contractions were observed in 76% of MMC cases.

CONCLUSION

Newborns with MMC exhibited distinct bladder characteristics on dynamic ultrasound compared to healthy controls, suggesting potential usefulness of dynamic ultrasound for evaluating these patients. However, additional validation is needed because of the examiner-dependent nature of ultrasound, small sample size, and lack of comparison with urodynamic studies.