LONG-TERM UROLOGICAL FOLLOW-UP OF OCCULT SPINAL DYSRAPHISM IN CHILDREN

From 1980 to 1996 we followed up 65 children with occult spinal dysrap hism (OSD) out of 85 observed in our urodynamic laboratory. The averag e age at diagnosis was 4.7 years (range: 1-21 years). In 19 cases (22% ) the OSD was associated with anorectal anomalies (ARA). Urinary incon tinence or voiding anomalies with urinary tract infection were the pre senting symptom in 34 children (49%). At diagnosis all children underw ent complete neuro-urological and urodynamic evaluation. Thirty-eight patients underwent neurosur gical correction. Vesicoureteral reflux (V UR) was present or developed in 17 patients: 15 underwent endoscopic p rocedures and 2 required surgery, 2 needed bladder augmentation becaus e of upper tract and renal function deterioration. Urinary incontinenc e was treated mainly by intermittent catheterization and anticholinerg ic drugs, but endoscopic treatment was performed in 3 children. Bt lon g-term follow-up (2 to 14 years), socially acceptable continence was a chieved in 78% of 57 children (8 could not be assessed because they we re less than 4 years old). Upper urinary tract deterioration occurred in 15% and renal failure in 7.5%.