Abstract
1. Neuro-orthopaedic, urological and educational evaluation of 74 patients is reported. 2. Limb deformity was more frequent in patients with L3-L4 motor level. 3. Severe fibrosis rather than muscular imbalance provides the deforming force in a number of cases. 4. In 46 per cent. of the patients the bladder had a capacity of less than 150 cc., 50 per cent. had trabeculations, 66 per cent. had upper urinary tract dilatation. 5. In 57 per cent. of the cases the bladder had a residual urine less than 20 cc. 6. In another series of patients followed up for several years 20 urinary diversions were done in 18 patients. In view of these series we advise Bricker type of ileal bladder unless huge dilated ureters are present, in which case Lapides butterfly ureterostomy provides the best answer to the urinary problems in myelomeningocele patients. 7. Six patients had cutaneous vesicostomy with bad results. 8. In approximately 200 patients tested in our institute about 60 per cent. would benefit from schooling and vocational guidance. Eight months ago the building of a home-school was started in order to fulfil this need. The cost has been calculated to be 700,000 American dollars.
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