Bladder in Myelomeningocele

In a recent paper, good correlation was shown between the nature of the bladder disorder and the neurological picture in infants and young children suffering from myelomeningoceles (Stark, 1968). According to the function of the 2nd-4th sacral segments on clinical examination of the lower limbs, patients could be classified into 4 groups (Fig. 1). Those in Group A (at least one leg neurologically normal) proved to have normal bladder function. Conversely, patients in Group D (flaccid paraplegia below Si) had inert bladders with no detrusor activity. Children with either incomplete voluntary activity (Group B) or purely reflex function (Group C) in S2-4 proved in 90% of cases to have an active bladder detrusor. In more than half of these, however, bladder emptying was highly inefficient. As this appeared to be due to failure of the striated external sphincter to relax during detrusor contractions, it was suggested