title: Management of the urinary tract in spina bifida cases varies with lesion level and shunt presence.
abstract: OBJECTIVE
  The urinary and gastrointestinal tracts remain an enormous burden to the patient with spinal dysraphism. We examined our cases to determine the relationship between the level and type of spinal dysraphism, presence of a ventricular shunt, and urinary and gastrointestinal tract management.
  
  
  METHODS
  After receiving ethics approval we reviewed the charts of 155 patients younger than 17 years with spinal dysraphism. We compiled all pertinent neurological, genitourinary and gastrointestinal outcomes from our pediatric and adolescent spina bifida clinic.
  
  
  RESULTS
  Of our cohort 43% performed clean intermittent catheterization, including significantly more patients with myelomeningocele vs those with lipomeningocele or tethered cord (73% vs 19%, p <0.01). The intestinocystoplasty rate varied with lesion level and was significantly higher in cases of thoracic and thoracolumbar lesions than in cases of tethered cord, lipomeningocele and sacral myelomeningocele (p <0.005). Of the patients 52% older than 5 years were continent of urine but this varied significantly with lesion level and ventricular shunt presence. The urinary continence rate was highest in patients with a tethered spinal cord (57%), lipomyelomeningocele (65%) or sacral myelomeningocele (60%) (vs thoracic and lumbar myelomeningocele p <0.005). However, there was minimal difference between lumbar and thoracic lesions (25% and 26%, respectively). Of our patients 73% were also continent of feces, which did not vary with lesion level.
  
  
  CONCLUSIONS
  Our data confirm the association of lesion level, a ventricular shunt and continence.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. pmetcalf@ualberta.ca
authors.forename: Peter
authors.initials: P
authors.lastname: Metcalfe
authors.forename: Darren
authors.initials: D
authors.lastname: Gray
authors.forename: Darcie
authors.initials: D
authors.lastname: Kiddoo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications* / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology* / Q000628:therapy*; D017287:Ventriculoperitoneal Shunt