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Bladder dysfunction and neurological disability at presentation in closed spina bifida
  1. L B Johnston,
  2. M Borzyskowski
  1. Department of Paediatric Neurology, The Newcomen Centre, Guy’s Hospital, London SE1 9RT, UK
  1. Dr Borzyskowski.

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.

  • Clinical signs are often missed in newborns, delaying diagnosis until later childhood when patients present with urinary incontinence, failure of toilet training, urinary tract infection, or orthopaedic problems.

  • Neither the clinical neurological deficit, which tends to be minor, nor the history of voiding habit are reliable indicators of the severity of bladder dysfunction and subsequent risk of renal damage.

  • Videourodynamics demonstrated that children with closed spina bifida suffer the full spectrum of lower urinary tract dysfunction seen in children with open spina bifida, despite their good mobility: in this study fewer than half of patients had a normal renal tract ultrasound scan but most had at least one abnormality on videourodynamic testing.

  • Upper urinary tract involvement and renal impairment may already be present when the first bladder problem is manifest: a quarter of cases in our study had renal scarring at presentation.

  • closed spina bifida
  • videourodynamics
  • neuropathic bladder dysfunction
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