Neurogenic Bladder (Differential Diagnosis as before)

mikt_17a_n.jpg and mikt_17b_n.jpg: IVU of a toddler with sacral myelomeningocele prior to and after intermittent clean catheterization. Notice the enlarged interpeduncular distance of the first sacral vertebra. mikt_17a_n.jpg: Dilated pelvicocaliceal system and dilatation of the whole ureter on the left side. On the right side, 3/4 of the ureter are visible and dilated. mikt_17b_n.jpg: IVU following regular intermittent clean catheterization (= CIC) during daytime and continuous catheter drainage of the bladder during nighttime. The pelvicocaliceal system is now normal on both sides; except for the visible right ureter in its upper quarter, the ureters are not visible and therefore not dilated. mikt_17a_n.jpg and mikt_17b_n.jpg: Following a neurogenic bladder with detrusor-sphincter dyssynergy in myelomeningocele a secondary grade 1 (I) reflux on the right and grade 3-4 (III-IV) reflux on the left side has developed due to functional infravesical obstruction. This reflux disappears following CIC, and the danger of upper urinary tract infection is also reduced with its possible damage to the kidneys and renal insufficiency; in addition, a socially acceptable continence can be achieved.