Occult spinal dysraphism: neurogenic voiding dysfunction and long-term urologic follow-up.
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.
Silveri
M
M
Divisione di Chirurgia Pediatrica, Ospedale "Bambino Gesù", P.zza S. Onofrio 4, I-000165, Rome, Italy.
Capitanucci
M L
ML
Capozza
N
N
Mosiello
G
G
Silvano
A
A
Gennaro
M D
MD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000503:physiopathology; D016136:Spina Bifida Occulta / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery