BLADDER FUNCTION BEFORE AND AFTER SELECTIVE DORSAL RHIZOTOMY IN CHILDREN WITH CEREBRAL-PALSY

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.