Bladder dysfunction and neurological disability at presentation in closed spina bifida

Abstract

Congenital closed spinal anomalies are associated with distortion of the spinal cord, the spinal nerve roots or both, and can result in neurological abnormalities of the lower limbs and neuropathic bladder dysfunction. This study reports clinical and videourodynamic findings in a group of 51 patients with closed spina bifida. The mean age at presentation to a specialist neurourological clinic was 3.3 years. Twenty five patients presented with urinary tract disturbance and 12 presented with neurological problems. Thirty three had normal neurological examination or only minor objective signs, 21 had normal renal tract ultrasonography but only two patients had normal videourodynamics, with 31 having two or more abnormalities during this assessment. Neither clinical neurological assessment nor the history of voiding behaviour are reliable indicators of bladder dysfunction and subsequent risk of renal damage. Therefore, all patients with a known or suspected diagnosis of closed spina bifida should have videourodynamic assessment.

The Effect of Surgery for Split Spinal Cord Malformation on Neurologic and Urologic Function

“…All patients in this study underwent UDS, and the conclusion was that the history of voiding habits and the neurological examination were unreliable indicators of bladder dysfunction. The authors determined that all patients with this diagnosis merit urologic evaluation [11], which was in accord with the findings of other authors [13, 14]. …”

“…While this is a beneficial fact for the population of patients with SSCM, it indicates that following the urologic status only by clinical testing of lower urinary tract function may be inaccurate and can miss subtle but significant deterioration in spinal cord function. Urodynamic testing can reliably capture early changes in spinal cord function indicative of tethering [7, 8, 9, 10, 11, 12, 13, 14], and can help in weighing the risks of an operative versus a conservative approach in the group 2 patients, and in defining the implications of the SSCM for the parents of group 1 patients.…”

Falso residuo postmiccional diagnosticado por videourodinamia

“…Vejiga neurógena, dado que no siempre existe correlación entre la evaluación neurológi-ca, la clínica miccional y la disfunción vesical subyacente. La videourodinamia permite estudiar las combinaciones entre las alteraciones de la fase de llenado y vaciado, y su relación con existencia de reflujo, morfología vesical, y alteraciones del funcionalismo vésico-esfinteriano durante el vaciado 8,9 . Consideramos que los pacientes con residuo elevado y reflujo de alto grado, constituyen una indicacion para la videourodinamia, dado que nos permite descartar la presencia de orina procedente del reflujo, como causa de falso residuo postmiccional.…”

Prognosis of Spina Bifida in the Era of Prenatal Diagnosis and Termination of Pregnancy

“…widely used. Lower spinal levels increase the chance that the child will be able to walk [10,11] , but this is also related to a higher incidence of neuropathic bladder [14,19,20] . The likely intellectual outcome tends to be worse when the degree of ventriculomegaly is more severe [9,20,21] .…”