Spinal dysraphism and neurogenic bladder: Still a relevant topic

Abstract

Background:The spinal dysraphism (SD) is a common disease in children. It remains a current topic because of its bladder and sphincter disorders' (BSD) impact involving the vital and functional prognosis. Myelomeningocele is the most severe form of spina bifida (SB). Objective: To highlight the BSD in SD patients and their features. Materials and methods: We conducted a retrospective study including patients followed in our Physical and Rehabilitation Medicine (PRM) Department and having BSD associated with SD. We collected epidemiological and clinical characteristics, such as neurologic level, orthopedic deformities, assistive device use, and level of ambulation in addition to biological, radiological and urodynamic features, care and follow-up. Results: Fifty patients, 30 girls and 20 boys, average age 10.33 ±1.28 years, mean length of follow-up 5.8 years. The most common type of SD was myelomeningocele, 30 had an independent ambulation. Urinary symptoms were dominated by urinary incontinence. The serum creatinine was disrupted in 18 cases including one with end-stage renal disease performing hemodialysis. Urine tests showed a urinary tract infection in 35 patients. The radiographic abnormalities were hypertonic bladder in most cases. Urodynamic exploration objectified an overactive bladder in most cases. The preferential micturition way was intermittent catheterization associated, in most cases, with anticholinergic treatment and in one case the intra-detrusor botulinum toxin. Conclusion: The BSD in children with SD remain a major issue requiring early and multidisciplinary care to preserve the integrity of the upper urinary tract and to improve the quality of life.