Management of myelomeningocele.

The care of the patient with myelomeningocele has improved over the last 15 years. Early diagnosis of urodynamic abnormalities and close monitoring of the urinary tract by ultrasonography have allowed the institution of prompt, effective therapy before upper-tract deterioration can occur. The wide acceptance of clean intermittent catheterization can in most circumstances eliminate the need for urinary diversion. Clean intermittent catheterization can alleviate reflux and in 85 per cent of children can promote continence. The adolescent and adult will continue to require observation and management to ensure their active place in society.