Neurogenic bladder in infants born with anorectal malformations: Comparison with spinal and urologic status

Background/Purpose: Spinal dysraphism and neurovesical dysfunction (NVD) fr equently are associated in children with anorectal malformations (ARM). Thi s study compares the urodynamic data from a selected group of patients with the results of their spinal and urologic imaging studies. Methods: Twenty-six children (20 with isolated imperforate anus and six wit h persistent cloacal malformations) were investigated. All patients were ev aluated with leak point pressures (LPP), renal ultrasound scan, and voiding cystourethrography. Eight children had urodynamics performed before and af ter posterior sagittal anorectoplasty (PSARP). The spinal cord was assessed using ultrasonography or magnetic resonance imaging. Current urologic stat us was obtained to provide long-term follow-up. Results: Twenty-one of 26 children demonstrated elevated LPPs above the est ablished normal value of 40 cm H2O, and 15 of these children had normal spi nal imaging study findings. Uroradiographic studies findings showed that 12 of 21 children with elevated LPPs had hydronephrosis or vesicoureteral ref lux with seven of these patients having normal spinal cords. LPPs in the ei ght patients with pre- and postoperative studies were 74 +/- 14.7 cm H2O an d 68 +/- 31.8 cm H2O (mean I SD), respectively. Conclusions: These urodynamic and radiographic data confirm that NVD (eleva ted LPP) is common. in patients with anorectal malformations despite normal spinal cords. Bladder dysfunction does not appear to be a sequelae of a pr operly performed PSARP. Patients with ARM and any uroradiographic or clinic al urologic abnormality should undergo urodynamic testing even though the s pinal studies are normal. Copyright (C) 1999 by WE. Saunders Company.