Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction

Objective To investigate in a prospective study the clinical and urodynamic characteristics associated with the correlation previously reported betwee n nonneuropathic bladder sphincter dysfunction and minimal meatal deformiti es in girls. Patients and methods From January 1995 to June 1996 all girls referred for urodynamics to investigate nonneuropathic bladder sphincter dysfunction wer e examined for meatal anomalies. Two types of meatal anomalies were recogni zed, i.e. hypospadias, in which the urethral meatus is displaced dorsally a nd meatal web or covered hypospadias, in which there is a mucosal web on th e dorsal side of the urethral meatus that deflects the urinary stream anter iorly. The girls presenting with minimal meatal deformities were compared w ith those presenting a normal meatal configuration for their history and vi deo-urodynamic features. Results During the study, 288 girls were referred for video-urodynamics; 88 presented with meatal anomalies (24 hypospadias and 64 covered hypospadias ) and comprised the study group; ail other girls were considered as the con trol group. Incontinence during the day was more frequent in the study grou p (56%) than in the control group (34%) (P = 0,003), Nocturnal enuresis was more frequent in the control group (87%) than in the study group (68%, P = 0,006). Urge was more frequent in the study group (80%) than in the contro l group (65, P = 0.02), as was anterior deflection of the urinary stream (v oiding over the toilet rim, in 48% and 4.5%, respectively (P < 0,001). On v ideo-urodynamical dysfunctional voiding (detrusor sphincter dyscoordination during voiding) was more frequent in the study group (59%) than in the con trol group (38% P = 0,009), and vaginal voiding was more frequent in the st udy group (40%) than in the control group (11.5%. P < 0.001), Conclusion Girls presenting with meatal anomalies have more severe dysfunct ion, as estimated by urodynamics. Although the natural history of these ano malies and the incidence in the normal population is not known, it is thoug ht that there is an aetiological correlation between the functional voiding disorders and the meatal anomaly. Surgical treatment to correct the anomal ies is proposed.