Urinary Tract Complications in 94 Patients with Spinal Dysraphisms

Congenital neurospinal dysraphism is the most common cause of neurogenic bladder among children. Myelomeningocele, which is the most common type of these lesions, is associated with neurogenic bladder in more than 90 percent of cases. Due to critical consequences of this disorder and high worldwide prevalence of urinary complications in these patients and because of no previous studies in our country, we evaluated patients with various types of spinal dysraphism refered to Labbafinejad and Mofid hospital between 1999 and 2005. In this study which was carried out on existing data, we evaluated 94 patients with various types of spinal dysraphisms. Type of spinal dysraphism, history of pyelonephritis, vesicoureteral reflux, renal damage, urinary incontinence, paraclinic findings, type of treatment and outcome of disease were reviewed in the patients records and these data were entered in to a data sheet and reported by descriptive-analytic statistics. Sixty eight patients (72.3%) had at least one episode of pyelonephritis. Hydronephrosis was reported in 34.1% of patients as well as vesicoureteral reflux in 35.1%, renal atrophy in 13.9% and end stage renal failure in 3.2% of them. Among 61 patients aged 4 years or older, 47 (77%) had urinary incontinence. Urodynamic studies were performed in 17% of patients to evaluate lower urinary tract function. Seventy six cases (80.9%) had paraclinic findings in favour of neurogenic bladder, from whom 59.2% had recieved medical treatments (CIC, anticholinergic agents, or both) to improve complications of this disorder; the mean age of these patients was 4.8 ± 4.4 years at the onset of medical treatments. Cystoplasty was performed in 35.1% of cases. Antireflux surgery was also performed in 9 patients (9.6%). 7 cases out of them underwent surgery without having any treatment for the underlying cause of reflux; in later follow-up, vesicoureteral reflux had relapsed in 6 cases of these latter group. It seems that urodynamic studies are the most accurate means in evaluation of lower urinary tract function and performing these studies in patients with spinal dysraphisms (in newborn period or early infancy) is necessary for diagnosis of urinary tract dysfunction and planning up the most appropriate management for these patients. Failure to treat the underlying cause of secondary vesicoureteral reflux would significantly jeopardize the success rate of any surgery that might inadvertently be done in an attempt to correct the problem.