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A total of 61 patients with myelodysplasia underwent water cystometry and electromyography of the external sphincter. Of these patients 27 underwent video fluorourodynamics as a part of preoperative evaluation or instead of a voiding cystometrogram. Renal quantitative scintillation camera studies detected 7 patients with mild upper tract deterioration, even when other tests failed to do so. A total of 31 patients had upper tract deterioration as detected by excretory urography, ultrasound and/or renal scan studies, and were designated as group 1, while 30 had normal upper tracts and were designated as group 2. Bladder compliance in group 1 was significantly lower than that in group 2 (4.5 versus 11.3 ml./cm. water, p = 0.001). Leak pressure in group 1 was significantly higher than in group 2 (42.3 versus 26.1 cm. water, p = 0.019). In summary, patients with evidence of upper tract deterioration had lower bladder compliance and higher leak pressure than patients with normal kidneys.

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A total of 43 infants with spina bifida was evaluated with a standard simplified urodynamic technique to determine whether bladder behavior altered with development and the optimal timing for urodynamic testing. Using urodynamic evaluation plus renal ultrasound and voiding cystourethrography the patients were divided into 2 groups: 1) those with a favorable prognosis and 2) those with an unfavorable prognosis. Only 55% of the initial urodynamic studies were predictive of future clinical course. The patients who worsened generally did so in the first 6 months of life. Of the patients initially believed to have an unfavorable prognosis 86% improved or stabilized with therapy. Urodynamic testing appears to be an important adjunct at 6-month intervals in infancy and early childhood as bladder behavior continues to evolve.