PREEXISTING NEUROGENIC VOIDING DYSFUNCTION IN CHILDREN WITH IMPERFORATE ANUS - PROBLEMS IN MANAGEMENT

We evaluated 22 boys and 2 girls 1 month to 8 years old with imperfora te anus to determine the relationship between neurogenic voiding dysfu nction and bony sacral or spinal cord anomalies. Lower urinary tract f unction before anorectoplasty was normal in 12 children (group 1), abn ormal (detrusor-sphincter dyssynergia) in 9 (group 2) and not evaluate d in 3 (group 3). High lesions of imperforate anus were present in 22% of the patients in group 1 and in 100% of those in group 2. Plain rad iography revealed partial sacral agenesis in 1 child in group 1 and 4 in group 2. Magnetic resonance imaging detected occult spinal dysraphi sm in 1 patient in group 1 and 2 in group 2. (Occult spinal dysraphism included sacral lipoma, tethered cord, syringomyelia and thick filum terminale.) Seven children in group 2 had vesicoureteral reflux before anorectoplasty. All children in group 2 were placed on clean intermit tent catheterization for the management of neurogenic voiding dysfunct ion. Normal upper urinary trace function was maintained in all patient s in group 1 and 6 in group 2. The remaining 3 children in group 2 had high grade reflux at presentation associated with severe renal damage or noncompliance with clean intermittent catheterization. These findi ngs indicate that in children with imperforate anus lower urinary trac t function should be evaluated before anorectoplasty because of the hi gh incidence of associated congenital neurogenic voiding dysfunction a nd the potential risk for renal deterioration. When possible, neurogen ic voiding dysfunction should be managed with clean intermittent cathe terization to prevent renal damage.