URODYNAMIC FINDINGS IN CHILDREN WITH SPINAL-CORD ISCHEMIA

Purpose: We identified urodynamic patterns of lower urinary tract dysf unction in children after anterior spinal artery injury. . Materials a nd Methods: Between 1981 and 1993, 6 boys and 1 girl in whom ischemic spinal cord injuries developed after umbilical artery catheterization (4), cardiovascular surgery (2) and spontaneous bleeding from an arter iovenous fistula (1) were evaluated radiologically, neurologically and urodynamically. Results: Neurological assessment revealed a motor lev el from T8 to S1 in all 7 children, whereas only 3 had sensory denerva tion ranging from T8 to L4. Urodynamic studies demonstrated a mixed up per and lower motor neuron pattern in 3 patients, a lower motor neuron lesion only in 3 and a pure upper motor neuron deficit in 1. Treatmen t consisted of oxybutynin in 5 cases, Crede voiding in 1 and close obs ervation in 1. All children are dry and kidney function has remained s table. Conclusions: Spinal cord ischemia in children is a rare conditi on that can arise from a variety of causes, the most common of which a re embolism from umbilical artery catheterization and surgical repair of a patent ductus arteriosus. The urodynamic patterns are variable bu t characteristically they can be upper or lower motor neuron in nature . Precise testing will lead to appropriate therapy to prevent upper ur inary tract disease and minimize incontinence.