Urinary Tract Problems

Urinary tract problems were at one time a primary cause of morbidity and mortality in children with meningomyelocele. Neurogenic bladder with chronic retention from dyssynergia, overflow incontinence, dribbling incontinence from an open bladder neck, vesicoureteral reflux, renal calculi, and urinary tract infections are common problems in this population. Children may be on prophylactic antibiotics, oxybutynin, or imipramine in an attempt to eliminate infections, minimize upper tract damage, and assist in the development of urinary continence. The side effects of the latter two are given in Tabje 1.34-3. Urinary tract colonization has been described in 60 to

70 percent of this population, and in the absence of vesicoureteral reflux, treatment is reserved for those with symptomatic urinary tract infection. Use of nitrofurantoin, trimethoprim-sulfamethoxazole, or amoxicillin is advised until culture results are available to minimize development of resistant strains of bacteria. Prior to treating an infection, it is important to know what antibiotics are currently in use. If broad-spectrum antibiotics have been used recently, there is an increased potential for a monilial infection.

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Sleep Apnea

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