title: Occult spinal dysraphism: neurogenic voiding dysfunction and long-term urologic follow-up
abstract: From 1976 to 1994, we followed 55 children with occult spinal dysraphism (OSD). The average age at diagnosis was 4.5 years (range: 24 days - 21 years). In 13 cases the OSD was associated with anorectal anomalies. Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OSD. At diagnosis, all children underwent complete neurourologic and urodynamic evaluation. Nine required early neurosurgical correction, before 3 years of age. During follow-up, intermittent clean catheterization was started in all patients. Vesicoureteral reflux was present or developed in 17 patients: 15 underwent endoscopic procedures and 2 required bladder augmentation because of upper-tract and renal-function deterioration. Endoscopic treatment for urinary incontinence was performed in 3 children. At long-term follow-up (6 to 18 years), socially acceptable continence was achieved in 78% of the children; renal failure occurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children with OSD with or without neurosurgery.
authors.affiliation: Divisione di Chirurgia Pediatrica, Ospedale "Bambino Gesu", P.zza S. Onofrio 4, I-000165, Rome, Italy
authors.initials: M
authors.lastname: Silveri
authors.initials: ML
authors.lastname: Capitanucci
authors.initials: N
authors.lastname: Capozza
authors.initials: G
authors.lastname: Mosiello
authors.initials: A
authors.lastname: Silvano
authors.initials: MD
authors.lastname: Gennaro