OCCULT SPINAL DYSRAPHISM - NEUROGENIC VOIDING DYSFUNCTION AND LONG-TERM UROLOGIC FOLLOW-UP

From 1976 to 1994, we followed 55 children with occult spinal dysraphi sm (OSD). The average age at diagnosis was 4.5 years (range: 24 days-2 1 years). In 13 cases the OSD was associated with anorectal anomalies, Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OS D. At diagnosis, all children underwent complete neurourologic and uro dynamic evaluation. Nine required early neurosurgical correction, befo re 3 years of age. During follow-up, intermittent clean catheterizatio n was started in all patients. Vesicoureteral reflux was present or de veloped in 17 patients: 15 underwent endoscopic procedures and 2 requi red bladder augmentation because of upper-tract and renal-function det erioration. Endoscopic treatment for urinary incontinence was performe d in 3 children. At long-term follow-up (6 to 18 years), socially acce ptable continence was achieved in 78% of the children; renal failure o ccurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children wit h OSD with or without neurosurgery.