NEUROVESICAL DYSFUNCTION DUE TO SPINAL DYSRAPHISM IN ANORECTAL ANOMALIES

Spinal dysraphism (SD) has been found associated with functional abnor malities of anorectal anomalies (ARA) The incidence of SD in these chi ldren is probably underestimated and a complete neuroradiological inve stigation of the lower urinary tract function has not been carried out routinely. In a 2 gears time frame we performed urodynamic (UDS) eval uations on 14 patients (8 males and 6 females) with ARA who showed SD at Magnetic Resonance Imaging (MRI) studies. We divided them into 2 gr oups hy age: group A (5 to 18 months) and group B (3 to 12 years). The UDS findings were classified as upper (UMN) and lower motor neuron (L MN) lesion. Out of the 9 children included in group A, 5 showed normal urodynamic pattern, while 4 had pathological UDS findings suggesting UMN lesion. Among the older (group B) children only one had normal and 4 had pathological findings: 2 hyperreflexia suggesting UMN lesion an d 2 external sphincter denervation suggesting LMN lesion. These data s upport the hypothesis that the neurovesical dysfunction found in child ren with anorectal anomalies results from a possible association with spinal dysraphism. An early morphological evaluation of the spinal cor d is mandatory in all children with ARA prior to definitive surgical c orrection of the malformation. The low incidence of pathological UDS f indings in small children if compared to older ones suggest that SD, a lthough present, may be asymptomatic.