THE SPECTRUM OF SPINAL-CORD DYSRAPHISM AND BLADDER NEUROPATHY IN CHILDREN

The frequency of bladder neuropathy and its relationship to abnormalit ies of the neural axis on MR scan was examined in a group of 49 childr en with known occult spinal dysraphism and 148 children with daytime u rinary incontinence. Of the patients with known spinal dysraphism 55% had bladder neuropathy. There was no relationship between either the t ype of abnormality or the number of abnormalities seen on MR scan and the presence or absence of bladder neuropathy. 5 of the 9 patients wit h a normal card had neuropathic bladders. Four of the 148 patients wit h daytime wetting turned out to have spinal dysraphism. Of the rest, 5 1 patients required urodynamic studies and of these 12 had clearcut bl adder neuropathy. 15 patients had MR scans, all of which were normal. The range of urodynamic findings in those with bladder neuropathy was identical to the range found in patients with spinal dysraphism. On th e basis of these findings it is suggested that children with isolated bladder problems could well have spinal cord dysraphism as a cause of these the lesions being beyond the resolution of MR scanning. For thos e children with clearcut spinal dysraphism the absence of any relation ship between the bladder findings and the lesion places a question mar k over the potential benefits of neurosurgical intervention.