The Incidence of Upper Urinary Tract Deterioration among Iranian Neonates with Spinal Dysraphism

The preemptive management of urinary bladder dysfunction in children with spinal dysraphism has contributed to renal cortical loss and scaring leading to end-stage renal disease, however, there is no consensus regarding the management and follow-up of these patients.
The present study has been performed to find the incidence of upper urinary tract deterioration in Iranian newborns suffering from spinal dysraphism.
In a prospective study, neonates born with the diagnosis of spinal dysraphism anomalies referred to the Children’s Medical Center, Tehran University of Medical Sciences, Iran in 2015 and 2016 were enrolled in the study. Patients were classified into synergic, dyssynergic and complete denervation groups based on the urodynamic studies. All were followed for a year.
55 neonates with age range of 1-60 days were enrolled in the study. Five (9.1%) patients of the dyssynergic and complete denervation group, who were treated using clean intermittent catheterization, were complicated with severe febrile urinary tract infection. Hydrocephalus and vesicourethral reflux were seen in 23 (42%) and 16 (29.1%) patients, respectively. Upper urinary tract deterioration was significantly related to the type of urodynamic pattern (P = 0.02). The risk for upper urinary tract deterioration was highest in the dyssynergic group (seven out of 32 patients), while just one out of 12 patients in the complete denervation group and none in the synergic group experienced upper urinary tract deterioration.
This study showed that it may be an acceptable choice to perform urodynamic studies as soon as possible in all newborns diagnosed with spinal dysraphism and categorize them in low and high-risk groups.