Bladder in Myelomeningocele (Differential Diagnosis Voiding Disorder)

mikt_16a_n.jpg and mikt_16b_n.jpg: Endoscopic pictures of a 6.11-year-old boy with spina bifida. The mucous membrane is normal. In addition, multiple lines which are prominent and multiple cavities among them can be seen. The right orifice is canulated by a ureter catheter. At 10 to 11 o'clock a single cavity is visible close to the orifice and below the border of one of the multiple lines. mikt_16a_n.jpg and mikt_16b_n.jpg: The described changes are characteristic of a hypertrophy of the bladder muscles with pseudo-diverticula. The diverticulum close to the right orifice is called a paraostial diverticulum which may cause reflux if the orifice is involved in the increasing diverticulum ( mikt_16b_n.jpg). In neurogenic bladder - the presented pictures of a patient with myelomeningocele are typical for such a bladder - the described bladder changes are not due to a structural infravesical obstruction, but due to a functional obstruction in detrusor-sphincter dyssynergy. Chronic urinary retention with overflow incontinence and simultaneous hyperactivity of the detrusor muscle leading to secondary obstructive uropathy of the upper urinary tract are the sequels.