Am. Houle et al., BLADDER FUNCTION BEFORE AND AFTER SELECTIVE DORSAL RHIZOTOMY IN CHILDREN WITH CEREBRAL-PALSY, The Journal of urology, 160(3), 1998, pp. 1088-1091
Purpose: Approximately a third of children with cerebral palsy are exp
ected to present with dysfunctional voiding symptoms. Selective dorsal
rhizotomy, which is indicated for managing lower extremity spasticity
in children with cerebral palsy, also has the potential of affecting
bladder function. We evaluate the impact of selective dorsal rhizotomy
on bladder function by comparing preoperative and postoperative sympt
oms, and urodynamic parameters in children undergoing selective dorsal
rhizotomy for spasticity. Materials and Methods: We reviewed urodynam
ic studies in 25 boys and 15 girls with a mean age plus or minus stand
ard deviation of 5.43 +/- 2.1 years who underwent selective dorsal rhi
zotomy for spasticity at our institution between January 1992 and Sept
ember 1995. Urodynamics were performed preoperatively only in 22 patie
nts, preoperative and postoperatively in 13, and postoperatively only
in 5. Preoperative urodynamic studies were done within 2 weeks of surg
ery and postoperative studies were done at least 6 months after surger
y (mean 1.32 +/- 0.65 years). Results: Of the 35 patients with preoper
ative urodynamic studies total bladder capacity, pressure specific vol
umes and full resting pressure were abnormal for age in 23 (65.7%). In
addition, 17 of the 23 children (74%) were completely asymptomatic. I
n the group that underwent preoperative and postoperative urodynamic s
tudies there was significant improvement in total bladder capacity (p
<0.005) and pressure specific volumes (p <0.005) using the paired Stud
ent t test. All children had neurological improvement postoperatively,
5 of 7 (71%) who were incontinent preoperatively became continent and
none had deterioration on urodynamics. Conclusions: At least half of
the children with spastic cerebral palsy have clinically silent bladde
r dysfunction. Selective dorsal rhizotomy improves spasticity and sign
ificantly improves bladder storage characteristics. We propose that ur
odynamic studies be included in the evaluation of children with spasti
c cerebral palsy who are possible candidates for selective dorsal rhiz
otomy to treat lower limb spasticity.