SUMMARYThe pre‐operative and post‐operative urinary and skeletal findings in 23 cases of meningomyelocele requiring urinary diversion were reviewed by the author. Radiologically, postoperative renal function improved in 50% and deterioration was arrested, in some cases for at least 36 months, in another 40%, 10% showed some deterioration–none showed gross loss of renal function, and no deaths occurred.Subsequent development of hyperchloraemic acidosis appears to be due to distal nephron disease and can be adequately controlled by oral alkali. Control of the acidosis caused regression of the bone changes.The optimum age for performing the urinary diversion is thought to be two to three years– hopefully before any serious renal damage has occurred, and also allowing the child to‐commence any possible schooling free of urinary incontinence.
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