SPINA BIFIDA DENGAN TETHERED CORD, INFEKSI SALURAN KEMIH

KOMPLEKS DAN ANEMIA DEFISIENSI BESI

Elysa Nur Safrida, Agung Triono, Eddy Supriyadi

Bagian Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Gadjah Mada, RSUP
Dr. Sardjito, Yogyakarta

INTISARI

Spina bifida adalah salah satu gangguan penutupan neural tube yang menyebabkan
terjadinya malformasi kongenital dan mempengaruhi sistem saraf. Spina bifida
mielomeningokel atau meningokel sangat umum ditemukan di regio lumbosakral.
Berdasarkan tingkat keparahan spina bifida dan keterlibatan saraf tepi dan saraf tulang
belakang, dapat terjadi kelemahan ekstremitas bawah, dislokasi panggul, gangguan buang air
kecil dan buang air besar karena gangguan saraf yang menyebabkan retensi pada kandung
kencing dan usus yang disebut neurogenic bladder dan neurogenic bowel. Permasalahan
lanjutan yang dapat muncul adalah infeksi saluran kemih (ISK) berulang, refluks vesikoureter
dan hidronefrosis. Tindakan bedah penutupan meningokel dan mielomeningokel sedini
mungkin sangat diindikasikan.1,2 Manajemen suportif secara terintegrasi dan
berkesinambungan sangat penting dalam mencegah abnormalitas pada saluran kencing,
kelainan ortopedi seperti kifosis dan skoliosis serta kelemahan pada anggota gerak bawah.
Telah dilakukan pemantauan selama terhadap anak perempuan yang saat ini berusia 4
tahun 7 bulan dengan diagnosis awal pemantauan adalah spina bifida regio lumbosakral
dengan tethered cord syndrome post unthethered cord procedure, ISK kompleks dengan
hidronefrosis grade I-II, neurogenic bladder, refluks vesioureteral kiri grade IV-V, gizi
kurang, perawakan pendek (stunted), keterlambatan motorik kasar, dan anemia defisiensi besi
(ADB). Tatalaksana komprehensif dilakukan dengan melibatkan keluarga, dokter anak (sub
divisi nefrologi, neurologi, nutrisi dan penyakit metabolik, pediatri sosial, hematologi), ahli
bedah saraf, bedah urologi, fisioterapis, dan psikolog. Sebagian besar variabel yang dinilai
dan diintervensi dapat mencapai target pada saat akhir pengamatan. Beberapa variabel masih
belum dapat teratasi pada akhir pengamatan yaitu gangguan buang air kecil (BAK) dan ISK
berulang yang masih terjadi pada pasien, serta permasalahan anemia defisiensi besi.
Tatalaksana komprehensif harus tetap berjalan dengan baik sehingga kualitas hidup anak
optimal.

Kata Kunci: Spina bifida, infeksi saluran kemih, neurogenic bladder, anemia defisiensi besi
 SPINA BIFIDA WITH TETHERED CORD SYNDROME, COMPLEX URINARY
TRACT INFECTION AND IRON DEFICIENCY ANEMIA

Elysa Nur Safrida, Agung Triono, Eddy Supriyadi

Department of Child Health, Medical School, Universitas Gadjah Mada/Dr. Sardjito

Hospital,Yogyakarta, Indonesia

ABSTRACT

Spina bifida is a neural tube closure disorders that cause congenital malformations
and affect the nervous system. Spina bifida (myelomeningocele or meningocele) is very
common located in the lumbosacral region. Based on the severity of spina bifida and
involvement of peripheral nerves and spinal cord, a lot of morbidities can occur as the
weakness of the lower extremities, hip dislocation, retention in the bladder and intestine
called neurogenic bladder and neurogenic bowel. The problems continued to emerge is a
repeated urinary tract infection (UTI), vesicoureteric reflux and hydronephrosis. Meningocele
and myelomeningocele surgical closure is indicated to be done as early as
possible.1,2Integrated and sustained supportive management is essential in preventing urinary
tract abnormalities, orthopedic disorders such as kyphosis and scoliosis as well as weakness
in the lower limbs.
We monitor the girls aged 1 year 10 months for 30 months with the diagnosis at the
beginning of the monitoring are spina bifida in lumbosacral region with tethered cord
syndrome, complex urinary tract infection with hydronephrosis grade I-II, neurogenic
bladder, left vesioureteral reflux grade IV-V, stunted, wasted, gross motor delay, and iron
deficiency anemia. Comprehensive procedures performed involving families, pediatricians
(sub division of nephrology, neurology, nutrition and metabolic diseases, social pediatrics,
and hematology), neurosurgeon, urologist, physiotherapists, and psychologists. Most of the
variables assessed could achieve the target at the end of the observation. Several variables
still can not be resolved by the end of the observation, for example, disorder of urination and
recurrent urinary tract infections that still occur in patients, as well as the problem of iron
deficiency anemia. Comprehensive management should be done properly so that the quality
of life of children could be optimal.

Keywords: Spina bifida, urinary tract infection, neurogenic bladder, iron deficiency anemia