Suggested protocol for monitoring urinary tract disease in patients with myelomeningocele

	Bladder and renal ultrasound	VCUG*	CMG and EMG*
Purpose
	Detect hydronephrosis, hydroureter, assess bladder wall thickness	Detect vesicoureteral reflux, measure bladder capacity and postresidual volume	Assess bladder pressure, bladder capacity, urine flow rate, sphincter activity, and bladder emptying
Age
Birth	✓
3 to 4 months	✓	✓	✓
6 months	✓
9 months	✓
12 months	✓	✓	✓
18 months	✓
24 months	✓
3 years	✓	✓	✓
Every year thereafter	✓
Every 2 to 3 years thereafter		✓	✓

This table summarizes our general approach to urinary tract monitoring in patients with myelomeningocele. VCUG, CMG, and EMG* should be performed more frequently if there is a change in urinary continence, changes in ultrasound findings (eg, hydronephrosis), or recurrent urinary tract infections. Changes in lower urinary tract function may be an early sign of spinal cord tethering. For further details, refer to UpToDate's topic on urinary tract complications of myelomeningocele.

VCUG: voiding cystourethrogram; CMG: cystometrogram; EMG: electromyogram.

* Ideally, VCUG, CMG, and EMG are performed at the same time, in the form of a video-urodynamic study.

Modified from: Tarcan T, Bauer S, Olmedo E, et al. Long-term follow-up of newborns with myelodysplasia and normal urodynamic findings: Is follow-up necessary? J Urol 2001; 165:564.

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Suggested protocol for monitoring urinary tract disease in patients with myelomeningocele